The thumb plays an integral role in hand function. Traumatic amputation results in significant morbidity. With loss of the thumb, up to a 40% reduction in hand function may result. Thumb replantation must be attempted when possible. The goals of thumb reconstruction are to replicate normal function as closely as possible, minimize donor site morbidity, and expedite recovery. In the setting of a mutilated hand, the status of the remaining digits must be carefully assessed. Toe transfers, osteoplastic thumb reconstruction, and pollicization are commonly used. This article summarizes the indications and technical considerations in addressing the deficiencies after thumb amputation.