A Moberg palmar advancement flap was performed for pulp reconstruction of the thumb in 36 cases. No flap was lost. Eighty-three percent of the defects were closed without additional iatrogenic bony shortening of the thumb. Sensory testing showed normal sensitivity in 74% of the 25 patients studied at a mean of 27 months. Minor restrictions in the active range of motion in the interphalangeal joint were mainly attributable to a loss of hyperextension. No thumb showed a permanent flexion contracture. The flap alone did not result in a reduction in grip strength, but an additional bony amputation resulted in decreased strength of 3-point pinch grip. Seventy-two percent of the patients had no or only mild subjective complaints. The Disabilities of the Arm, Shoulder, and Hand questionnaire, which was used for the first time as a standardized measure to assess functional outcome after this procedure, showed only minor impairment levels (12.4 +/-). Based on these data, the Moberg advancement flap remains the procedure of choice for covering defects of the distal palmar thumb.