Owing to paucity of soft tissue in the fingers, the trauma to fingers can cause exposure of tendons, joints, and bone. Several flaps have been used to cover soft tissue defects of the fingers. From 2007 to 2010, we have operated on 18 male patients with skin defects of dorsal phalanges of fingers. We used reverse distally based venous flap with perivenous tissue to cover the defects. Their mean age was 30.6±8.6 (15 to 40). The etiology in all cases was severe trauma. Ten had defect in dorsal aspect of proximal phalanges and in 8 the defect was in the middle phalanges. One of our patients experienced superficial necrosis at the distal margin of the flap that was successfully treated with local wound care and dressing changes. There was 1 case of venous congestion that resolved itself. There were no postoperative wound infections. There were no serious complications. The venous flap with preservation of perivenous areolar network is a good option for coverage of soft tissue defects of proximal and middle phalanges of fingers.