Background: The thumb represents a critical role in overall hand function particularly by pinching and grasping thus, representing about 40% of actual hand function. Objective: Evaluation of different local and regional flaps in thumb reconstruction regarding function, sensation and aesthetic outcome. Patients and methods: The study included 20 patients with thumb defect admitted to Al-Azhar University Hospital in New Damietta for prospective cohort study. Results: Homodigital island flap was used in two cases (10 %), this type of flap proved to have excellent cosmetic and sensory results very close to FDMA flap, with privilege over FDMA flap in large defects where Homodigital flap proved to be better and provided adequate skin coverage. The flap was reliable, with good vascular and sensory supply, and provided thumb reconstruction in a single stage. 8 cases (40%) by volar advancement flap. Moberg flap was used in 8 cases. The flap was reliable, with good vascular and sensory supply, and provided thumb reconstruction in a single stage. This flap was found to be sufficient to cover no more than the distal one third of the distal phalanx of the thumb. Minimal flexion limitation at the interphalangeal joint occurred then returned to normal in all patients. Postoperatively, no flap loss occurred. Conclusion: V-Y, The Moberg`s flap, cross finger flap, the first dorsal metacarpal artery flap and homo-digital island flap. The volar advancement flap (Moberg's Flap) is the simplest and easier sensate flap used for reconstruction of thumb defects in distal third of distal phalanx less than one centimeter.