Eighteen finger pulp defects were reconstructed using a homodigital dorsal middle phalangeal neurovascular island flap procedure based on a single neurovascular pedicle preserving the length of the finger. All flaps survived and achieved adequate functional and cosmetic results. The mean follow-up time was 22 months. The mean value of static two-point discrimination test of the healed flaps was 7 mm and the mean value of moving two-point discrimination test was 5 mm. Range of motion was considered satisfactory in all reconstructed fingers except one, in which a 20 degree extension deficit at the proximal interphalangeal joint was observed. This flap represents a useful alternative for reconstruction of the fingers with large pulp defects.