Purpose: To assess the role of the microsurgical toe transfers to reconstruct digits of the hand severely injured by burns. Patients and Methods: A retrospective review of all patients with burn injury to their hands who underwent toe to hand reconstruction between 1990 and 2000 was undertaken. Demographic information, indications, operative details, and functional results were evaluated over a period of 6 months to 1 year postoperatively. Results: Seven male and 5 female patients of 28 years of age on average [range: 14 – 42] underwent toe to hand transfers following 4th degree burn [thermal or electric] injury acutely (2 patients) or secondarily (10). Among these patients, a total of 26 toes were transferred from 18 feet to reconstruct 4 thumbs and 22 fingers. Five combined 2nd and 3rd toes, two great toes, ten 2nd toes, and four 3rd toes were taken to restore the digits of the hand. The immediate postoperative recovery was unremarkable in 10 patients. Re-exploration was undertaken in one digit revealing arterial spasm and re-anastomosis of a thrombosed vein in another digit that was the only partial failure in this series. All donor sites healed without any complications. After healing was complete, six additional (minor) procedures were undertaken in 3 patients. Functional evaluation during follow-up revealed all digits recovering protective sensation as a minimum. Range of motion was restricted in 5 patients, but exhibited power grip strength of 10kg on average. Among the remainder however, recovery of range of motion of each digital joint and pulp to pulp pinch strength between reconstructed digits was satisfactory. Discussion: The microsurgical transfer of toes to reconstruct digits of the hand missing due to trauma or congenital absence is standard. Burn injury to the hand however brings additional complexity due to variable injury to the surrounding skin cover, underlying vital tissues and secondary problems arising from inadequate management during the initial injury period. If amputation is required either during the acute period or due to the useless ‘hook’ finger that is otherwise unreconstructable, a ‘replica’ is available from the foot with little donor site morbidity. Meticulous surgical technique and dedicated physical therapy is essential for success during the acute and late periods respectively. Conclusion: Burn injury leading to amputation of digits important for hand function is not a contraindication to the application of toe to hand transfer techniques for restoration of function and even form to the hand.