Background: Posttraumatic dorsal hand defects with exposed tendons and/or bones represent a challenge to reconstructive surgeons. Many options are suggested ranging from local, regional, distant up to free flaps. First dorsal metacarpal artery island flap was commonly prescribed for reconstructing the thumb or first web space defects. Methods: During a 30 month’s period, 23 patients, 15 males aged between 17 and 48 years and 8 females aged between 18 and 36 years presented by posttraumatic dorsal hand defects. Of them 18 had both exposed tendons and bones while 5 had exposed tendons only. The defects dimensions ranged between 3
4 cm and 4.5
6 cm. All defects were reconstructed by using a single stage first dorsal metacarpal artery island flaps. Results: All flaps survived completely without complication during the mean follow up period of 2 years. All patients were very satisfied both functionally and aesthetically by the procedure. Conclusion: Island first dorsal metacarpal artery flap is a good option for reconstructing mild to moderate dorsal hand defects with acceptable functional and cosmetic results.