Background: The hatchet flap is a single triangular flap with a partial bridge of the skin on one of its edges. It was used with success for defects on various parts of the body. The main objective of this study was to evaluate the effectiveness of this flap with fingertips. Methods: The study was conducted in Emergency Department, Cairo University hospital unit, during the period from January 2016 to June 2016. We recruited patients between 16 to 55 years who needed coverage of finger tip, with clean, sharp injury, presented during the first day of trauma. Patients were operated on using digital block anesthesia under finger tourniquet control and loupe magnification. For fingertip amputation, a triangular flap was planned obliquely toward the contra-lateral side of the defect with the tip point of the flap did not traverse the distal interphalangeal joint crease whenever it was possible. All cases have been followed up for three months for infection, hematoma, disfigurement, contracture and partial/complete flap failure. Results: Forty cases were thoroughly interviewed, investigated, treated and followed up over a three month period. Age ranged between 16-55 years with average age 30.87. Ninety-five percent of the cases were males (38 cases) while the rest were females, 90% were occupational according to the cause, and the rest were traumatic/household, according to Allen’s classification the majority (37.5%) of cases showed amputation level class II. Only 3 cases (7.5%) did not have bone exposed. The index finger was the most injured in our study (35%). Fifteen (37.5%) cases showed postoperative infection. Nineteen (47.5%) cases got involved in the physical treatment/ occupational therapy. Thirty (75%) cases had numbness in the injured finger. Only 12 (30%) cases completely survived. Conclusion: Despite the ongoing publications about new flaps for fingertip reconstruction, there is a lack of evidence to support improved healing and function in a surgically reconstructed fingertip compared to conservative wound management. Controlled trials are surely needed to declare whether surgery is superior to secondary healing or not. Keywords: Fingertips injury; Hatchet flap; fingertip amputation.