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Objective To introduce the clinical apply of middle and small skin defect in finger injury with lateral arm free penforator flap.Methods (1) Two cadavers were injected with a modified lead oxide-gelatin mixture.Later, CT scan, three-dimensional reconstruction of the cutaneous perforator vessels on the later arm.Then simulate the flap design.(2)18 cases of middle and small skin defect in finger injury were treated with lateral arm free flap.The defect area were from 3 ×4cm2 to 6×9cm2.The treatment effect was followed up.Results The flap of 18 cases survived after the operation.The wound of providing area was directly sutured or skin grafting and got healing.All cases were followed up for six months to three years, and the average follow-up time was 11 months.There was a little swelling on the outlooks of the flap, but the texture and sensation of the flap was good.According to the upper limb function assessment criterion issued by hand surgery association of Chinese medicine association, the hand function had excellent results in 7 cases, good in 8 cases, fair in 2 cases, and poor in 1 cases.Conclusions The lateral arm free perforator flap has a stable vessel pedicle,good texture and sensation, so it was a good method to repair middle and small skin defect in finger injury.