We read with interest the article by Wei et al[1] regarding the repair of fingertip defect using a flap based on the dorsal perforator.We believe that flaps based on the dorsal branches of the digital artery have been described previously by Bertelli and Pagliei[2] and others.[3] Although these flaps may be appropriate for soft-tissue reconstruction in selected cases, just like the traditional cross-finger flaps, we have major reservations about the aesthetic appearance of the donor site.Our centre’s philosophy has long been to pay great attention to cosmesis by minimizing the scarring on the dorsum of the hand and fingers. This also applies to our technique in syndactyly separation, which we have previously described.[4] In addition, fixing a skin graft onto the extensor tendon is more likely to result in stiffness.Our preferred method is to use homodigital island flaps, either advancement or reverse flow. These are reliable and provide coverage with glabrous skin, which is a better match than dorsal skin.[5] The donor site is more concealed with better cosmesis, and the extensor tendon is not tethered.We think that it is important to focus on cosmesis and function, not just survival, in the outcomes of fingertip defect repair.