Objective To report the results of aesthetic reconstruction of distal finger or middle-distal finger segment with transplant harvested from 2nd, 3rd or 4th toe. Methods In a series of 108 cases of distal finger or middle-distal finger segment defect, 141 fingers were reconstructed with transplants harvested from 2nd, 3rd or 4th toe according to the outward appearance of donor toe. The blood-supply was restored by anastomosis of digital artery and vein. In first-stage reconstruction, refinement of outward appearance was applied in doner toe if the toe pulp is bulky or middle part of toe was relatively thinner. Results One hundred and forty fingers survived. The successful rate was 99.3%. Among them, 81 patients had been followed up from 1 to 10 years (mean 3.5years) postoperatively. 61 cases were graded to be excellent and 16 eases good as assessed with Criterion of Functional Evaluation on Finger Reconstruction issued by Chinese Society of Hand Surgery. Conclusion For aesthetic reconstruction of distal finger or middle-distal finger segment, the 2nd toe is usually considered to be donor of first choice. In case the outward appearance of 2nd toe was inferior to that of 3rd or 4th toe, the 3rd or 4th toe should be chosen for better result. In some cases, revisional aesthetic surgery were necessary to refine the outward appearance in first-stage reconstruction.