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Abstract: A 27-year-old male suffered a severe work-related crush injury to his left dominant hand, resulting in a composite defect, including necrosis of the thumb and fingers as well as soft tissues distal to the radiocarpal joint. An amputation of the affected fingers had to be performed at the level of the metacarpophalangeal joints. In an attempt to prevent necrosis of the exposed carpal bones and metacarpal stumps, immediate coverage was achieved by reconstruction with a free rectus abdominis muscle flap, two weeks after the initial trauma. After six months, thumb reconstruction was accomplished by second toe transfer from the right foot. After another four months, the contralateral second toe was utilized for reconstruction of the fifth digit. Within two years after the accident, the patient returned to full-time occupational activities. He demonstrated excellent motor function, satisfactory discriminatory sensation to the transferred toes as well as protective sensation to the skin graft covering the flap. The donor site morbidity of both the toes and the rectus abdominis muscle was acceptable. After ten years following reconstruction, the patient had fully adjusted to his disability and was in full-time occupational activity with only minor limitations in his everyday life