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Objective To explore the clinical efficacy, advantages and disadvantages of free second toe in the reconstruction of thumb and finger defects in emergency. Methods From March 2010 to May 2017, 98 patients with thumb and finger defects (105 fingers) were collected. There were 18 cases of thumb, 33 cases of index finger, 31 cases of middle finger and 16 cases of ring finger. Defects or degloving injuries of index finger and middle finger at the same time were found in 9 patients. Eleven cases of defects were distal to the middle of the metacarpal bone, 53 cases were distal to the base of the proximal phalanx, 19 cases were distal to the proximal interphalangeal joint and 15 cases were distal segment. Thirteen cases of nerves were extracted from the proximal end about 3 to 5 cm, and the skin at the proximal end of defects was slightly contused. Twenty-nine cases (31 fingers) were reconstructed with the free second toe, and 69 cases (74 fingers) were reconstructed with the second toe combined with the dorsal foot flap. Regular follow-up after operation was performed to evaluate the appearance, function and condition of the donor site. Results All reconstructed fingers (105 fingers) survived and were followed up for 1 to 3 years. The appearance and functional recovery of the reconstructed fingers were satisfactory. According to the trial standard of the upper limb function evaluation of the Chinese Society of Hand Surgery, 87 cases (92 fingers) were excellent, 9 cases (11 fingers) were good and 2 cases (2 fingers) were poor. The excellent and good rate was 97.9%. No obvious hypertrophic scar and dysfunction was found in the donor site. There was no obvious discomfort in weight-bearing and walking. Conclusion Application of free second toe in the reconstruction of thumb and finger defects in emergency can restore good appearance and function, which is an ideal treatment method. [ABSTRACT FROM AUTHOR]