RESUMEN
The authors present a case of atypical thumb reconstruction in children, using a combined vascularized joint transfer and a free partial big toe transfer. They describe a burned hand with first metacarpal amputation and transproximal phalanx amputation of the index. According to the "bank finger" principle the metacarpophalangeal joint was transferred on the top of the first metacarpal, vascularized by the two collateral pedicles. The second metacarpal shaft was removed to create the first web and kept for bone grafting. A "wrap-around" flap (Morrison) with an intercalated bone graft completed this reconstruction. A first web orthesis was used to prevent retraction. Result at six months was functionally and cosmetically good, but the normal growth of the reconstructed thumb must be demonstrated by the future. Finally, the other procedures are considered.