1. Prehension is a complex mechanism for which both movement and sensation are required.

2. Two basic grips are considered: the digital pinch and palmar grasp, which are simpler expressions of the precision grip and the power grip. For the digital pinch the minimum requirement is a thumb or a reconstructed thumb, and a finger to which it can oppose. For palmar grasp mobile fingers are necessary so that they can wrap round the object grasped.

3. The restoration of prehension is considered under the following headings: mutilation of the fingers; mutilation of the thumb; and mutilation of both together.

4. The various methods of reconstruction are described that are appropriate to each type of mutilation, so as to provide restoration of length, mobility and sensation.

5. The indications for the various main methods to compensate for loss of the thumb are discussed. These methods include pollicisation and osteoplastic repair with neurovascular island flap.