Background <p>Reconstruction of finger defects remains challenging, especially when protective sensation and mobility are required. The distal dorsoulnar artery perforator free flap (DDUAPF) provides neuro-sensate soft tissue coverage with low donor morbidity. No systematic review has previously combined outcomes of the DDUAPF in digital reconstruction; this study addresses this gap, and highlights a potential modification.&#xa0;</p> Methods <p>A systematic search of Pubmed, Medline, EBSCO was performed. Screening followed PRISMA guidelines and the review was registered on PROSPERO (CRD420241137681). Outcomes included flap survival, complications, donor morbidity, range of motion (ROM), and sensory recovery. Study quality was assessed using Critical-Appraisal-Skills-Programme (CASP) checklist and Risk-of-Bias-In-Non-randomised-Studies-of-Interventions (ROBINS-I).&#xa0;</p> Results <p>Ten studies involving 178 patients and 184 flaps were included. Mean age was 33.7 years. Indications included trauma, degloving, infection, burns and ischaemia. Average flap size was 12.3 cm² (range 3- 71.5 cm²). Flap failure occurred in 0.5%, partial necrosis in 1.1% and cold intolerance in 6.5%. Donor morbidity was minimal. Sensory recovery of ³S3 on the sensory-British-Medical-Research (sBMRC) score was achieved in 56%. Static-2-point-discrimination (s2PD) ranged 4-14 mm, with a weighted mean of 9.2 mm across 160 patients. Of 120 patients assessed objectively, 74% achieved good-to-excellent ROM; in 26 subjectively assessed patients, 95% reported satisfactory function.</p> Conclusions <p>The DDUAPF is a versatile, pliable and neurotisable option for finger reconstruction, with the added advantage of tendon inclusion, if needed. It preserves forearm vasculature and minimises donor morbidity with similar or better outcomes than alternative flaps, but requires microsurgical expertise. Further homogenous studies are needed for meaningful meta-analysis.</p> <p>Level of Evidence: Not gradable.</p>