Metacarpophalangeal flexor replacement has a definite place in the treatment of intrinsic-muscle paralysis. In our hands, the transfer increased grip strength, reduced clawing, and improved flexor pattern. The transferred muscles are synergistic with finger flexion, so extensive physical therapy in the postoperative period is not required. The procedure itself is biomechanically sound and can be done early in the course of recovery from upper extremity peripheral nerve injury.