Objective　To report the anatomy and surgical methods and clinical effects of using the first metacarpal radial dorsal artery free flap for reconstruction of a finger soft tissue defect.　Methods　From December 2014 to July 2016, 6 fingers soft tissue defect were treated by microscopic reparation with the first metacarpal radial dorsal artery flap. The flap was designed in the radial aspect of the first metacarpal bone, the connection from the snuff box to the radiodorsal aspect of the first metacarpophalangeal joint serves as the axis, and the first metacarpal radiaodorsal artery and radiodorsal branch to the thumb from the superficial branch of the radial nerve were anastomosed, respectively, to the artery and nerve at the would. The flap sizewas about 2.5~4.0 cm×1.5~2.5 cm.　Result　6 cases all survived, and followed up for 2 to 8 months. The texture of flaps were soft and wear-resisting, and the appearance of that was satisfactory. The sensation of flaps was restored to S3~S3+ level and two-point discrimination was about 5.0~8.0 mm. The wounded area was sutured directly and healed in a linear scar. The activity of thumbs was normal and feeling of distal skin of flaps was diminished. Activity of all interphalangeal joints was not significantly limited and excellent in 4 cases, good in 2 cases according tothe TAM assessment criteria, and the excellent and good rate was 100%. Conclusion　The flap has consistent axial vessels, smaller damage area, easier harvest, better texture, more reliable blood supply and other advantages. It can help to reconstruct more satisfying feeling of wounded finger and provide a new and effective method to repair finger skin defect.