Objective To explore the operative methods and clinical effects of the reverse island flap pedi-cled with the dorsoulnar artery of the thumb for skin coverage of the thumb tip. Methods From February, 2013 to July, 2016, there were 11 cases of thumb tip defect distal to the superior nail fold who were treated with reverse dor-soulnar island flap, which was located on the dorsoulnar side of proximal thumb, and rotated with a 2 mm-wide pedi-cle at the dorsal arcade of the proximal nail fold. The skin over the rotated pedicle was sutured tensionless and the donor site was sutured directly. Postoperative follow-up was done termly. Results All 11 flaps survived eventually, and 9 cases were followed-up with a period of 3-38 months. Benefitting from the fair colored, well textured, plump but not bulky flap, the restored thumb had a satisfactory figure. The thumb also had good algesthesia and thalposis togeth-er with the flap. The thumb had a nearly normal ROM of interphalangeal joint and metacarpophalangeal joint, and opening angle of first web compared with the contralateral side. Conclusion The reverse island flap of dorsoulnar thumb, which is nourished with a constant vessel, is easily harvested and reliable. The flap can be used to repair the small skin defect of the thumb tip with a good result and few complication.