Destructive terminal palmar wounds of the thumb should be reconstructed if possible with like tissue; palmar glabrous skin served by the thumb's own median nerve branches. Such tissue is usually available, and no free flap or adjacent flap can serve as well. Seventeen thumbs of seventeen patients have been repaired with this method. The average follow-up was over 3 years. Sixteen of the 17 thumbs regained excellent sensibility and excellent pinch power based on current standard methods of evaluation; all patients returned to the same or similar occupations they had performed before the injury.