Thumb Tip Reconstruction Using a Modified Moberg Flap

The Moberg flap is a well-established technique for coverage of thumb volar pulp defects up to 1.5 cm, preserving finger sensation and length. However, larger defects may result in residual uncovered areas which could require additional procedures. We present an intraoperative modification of the Moberg flap that utilizes redundant tissue within the flap as a small propeller island to achieve distal coverage. A 50-year-old male with a 2×1.5 cm thumb pulp defect from a chainsaw injury underwent this procedure. After standard flap elevation, a 0.5×0.5 cm raw area remained distal to the flap margin. A redundant portion of the Moberg flap was elevated as an island on a preserved neurovascular branch, rotated and inset to cover the residual defect. Healing was uneventful, with excellent sensory recovery at 3 years. This modification does not replace the original Moberg flap but may serve as a practical salvage option when small uncovered distal areas remain after advancement.