Reconstruction of osseous defects of the distal phalanx of the thumb is usually addressed with free bone grafts or free vascularized bone flaps. Some reports demonstrated the possibility to harvest an osteo-cutaneous flap in the dorso-ulnar side of the first metacarpal bone with success. In the same manner, no reports are present in the literature in which bone deficits were reconstructed with this flap elevated as an exclusively osseous flap. We report our successful experience with one case of distal phalanx reconstruction of the thumb by mean of the dorso-ulnar reverse flow pedicled osseous flap. The patient was a 45-year-old woman with symptoms related to a cystic bone tumor that involved the entirety of the distal phalanx of the thumb. Flap dimensions were calculated based on x-ray gap measures, which resulted in need of 1.5 × 0.8 × 0.5 cm flap dimensions. An osseous flap was harvested and transposed from the ulnar side of the first metacarpal bone. K-wire fixation was utilized for bone flap stabilization. No complications occurred and excellent functional result was evaluated at 6 months follow-up. In our opinion, the flap may be considered as an alternative to free bone grafts in situations in which perilesional tissues may jeopardize the process of free graft taking and in cases in which free vascularized bone flaps are not feasible for patient or surgeon decision.
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