Introduction- Reconstruction of the thumb defect, while creating a robust and sensate flap, is a hard endeavour. First dorsal metacarpal artery (FDMA) flap is one regional flap that has been used for thumb cover, usually for defects up to interphalangeal joint or just distal to it. The present report is our experience of utilisation of FDMA flap for thumb reconstruction in 15 patients. Material and methods- This prospective study was conducted at department of plastic and reconstructive surgery of a tertiary care centre during the period of two year. A total of 15 patients with complex post-traumatic soft tissue thumb defects (8 dorsal oblique, 5 volar oblique and 2 transverse) were selected and defects were covered with 1st dorsal metacarpal artery flaps. Sensory function was evaluated with static 2-point discrimination and cortical reorientation. The mobility of the thumb was tested by the Kapandji score. The aesthetic outcome was assessed. Patient’s subjective satisfaction was evaluated by the visual analogue scale. Results- The patients included 4 females and 11 males ranging in age from 15 to 50 years (mean, 32.5 years). 8 patients underwent immediate surgery, whilst 7 patients came late following electric burn or trauma. Nine individuals (60%) experienced involvement of their dominant hand. The flap sizes ranged from 19×13 mm to 40×27 mm (mean 32.1×17.6 mm). 13 flaps were entirely viable, while 2 exhibited distal flap necrosis, which was managed conservatively and healed through secondary intention. The average follow-up duration was 18.3 months (range 9-30 months). The static two-point discrimination (s2-PD) varied from 7 to 16 mm, with a mean of 10.5 mm. Cortical reorientation was achieved in 8 patients (53.3%). The mean Kapandji score was 7.2 (range: 4-9). The average subjective satisfaction (SS) score was 8.1 (range: 4-10). The aesthetic results of the donor and recipient sites were classified as excellent in 5 (33.3%) patients, good in 8 (53.3%) patients, and poor in 2 (13.3%). Conclusion- The first dorsal metacarpal artery flap provides sensitive, flexible covering for mild to moderate thumb defects. The procedure yields positive functional and aesthetic results with acceptable donor site morbidity.