Congenital absence or traumatic amputation of the thumb is a major disability profoundly disturbing the function of the hand, as the thumb represents an estimated 50% of total hand function. The methods for thumb reconstruction utilizing the index finger were developed some twenty years ago, and progress has been made in the last several years with emphasis on intrinsic muscle reconstruction as emphasized by Buck-Gramcko. The method, technique and anatomy of index pollicization is discussed, and representative cases presented for congenital absence of the thumb and for traumatic amputation of the thumb.