Background: Fingertip amputation is the most common amputation affecting the upper extremity. Some operative procedures near the fingertip may cause soft tissue defects. Diverse techniques are used to repair these defects, including skin graft, local or regional flap procedures, and partial toe transplantation. Both functional restoration and aesthetic repair are important but controversial. This study reports the postoperative results using a reverse homodigital island flap for fingertip reconstruction based on our own clinical experiences. Method: From March 1996 to December 2004, we collected data from 28 patients with soft tissue defects of the distal phalanx that were reconstructed using a reverse homodigital island flap. Medical records included information about sex, dominant hand, frequency of finger injury, mechanism of injury, flap size, donor site coverage, survival rate, and sensory recovery following surgery. Results: Operation time ranged between 70 and 110 minutes (mean, 90 minutes). The donor site was repaired by direct closure in 16 patients and covered by a split-thickness skin graft in 12 patients. All flaps but one survived completely. Follow-up ranged from 12 to 28 months. The static two-point discrimination test score recovered to 5.6-8.8 mm. Conclusion: A reverse homodigital island flap is useful for fingertip reconstruction because it preserves optimal function in a one-stage procedure.