Terminal amputations with loss of the distal pulp are common injuries. This report analyses 64 consecutive cases of advanced or exchanged homodigital neurovascular island flaps operated on by one surgeon between 1981–1986. The surgical technique, indications, contra-indications and five year results are evaluated. Overall, these flaps provide reliable vascularity as well as normal sensibility at the distal end of the finger where high quality perception is required.