Fifteen neurovascular pedicle transfers of the abductor digiti quinti to the base of the proximal phalanx of the thumb were performed: seven for laceration of the median nerve, seven for neurological disease, and one for congenital absence of the thenar muscles. Fourteen of the transfers were viable, and twelve gave excellent results. The three failures all had had inadequate release of contractures of the thumb. This transfer offers the following advantages over other opponensplasties: (1) an intrinsic muscle with correct amplitude and direction of pull replaces intrinsic muscles; (2) the tension of the muscle transfer is automatically correct; and (3) the appearance of the hand after this procedure is superior to that after other types of opponensplasty.