When replantation of an avulsed/amputated thumb is not feasible, toe-to-hand transfer should be considered as a reconstructive option in appropriately chosen patients. Although selection criteria should be followed, immediate one-stage transfer, as opposed to a delayed secondary procedure, provides many advantages. Primary reconstruction reduces hospitalization as well as surgical and recovery time, expedites return of function and may allow patients to return to work sooner. The psychological preparation required, the need to understand potential risks and the ability of the patient to undergo extensive microvascular reconstruction are important factors as well. In the past five years, six hand trauma patients underwent great toe-to-hand transfer during their initial hospitalization and within the acute phase of their recovery at our medical center. The overall results of these thumb reconstructions were retrospectively evaluated, specifically in regard to patient demographics, length of stay, complications (infection, contracture, reexploration) and time to return to work/normal activity. We also calculated objective and subjective scores to quantify patient satisfaction and clinical success. All of our patients were laborers who suffered work-related avulsion-amputations. No complications were reported during initial hospitalization, which lasted an average of 12 days. Donor site morbidity was minimal. The data suggest that thumb reconstruction using great toe transfer can be safely and reliably performed as a primary procedure in selected patients. The economic and therapeutic advantages should be weighed against the risks associated with this approach when evaluating thumb avulsion-amputations.