OBJECTIVE To compare the results of 2 reconstructive options (the de-epithelialized cross-finger flap vs the adipofascial turnover flap) for coverage of small complex dorsal digital defects. METHODS A total of 73 patients with small complex dorsal digital defects were included in the study and were classified into 2 groups: group 1 (n = 31) had reconstruction using the de-epithelialized cross-finger flap and group 2 (n = 42) had reconstruction using the adipofascial turnover flap. The type of complication and patient dissatisfaction with the appearance of the donor site were documented in each study group. RESULTS All flaps in both groups survived with no infection or hematoma. Specific complications were found in group 1 patients and included flap dehiscence (1 patient), considerable skin graft loss (2 patients), stiffness of the donor finger (5 patients), and inclusion cyst (1 patient). The only specific complication for group 2 patients was the occasional epidermolysis of the skin of the donor site, which was observed in 6 patients. Patient dissatisfaction with the appearance of the donor site was documented in 10 patients in group 1 and none in group 2. The elective flap division in the cross-finger-flap group was considered a disadvantage in children because it required general anesthesia. CONCLUSIONS The versatility of both flap techniques in digital reconstruction is confirmed; however, considering the type of complication and the need for general anesthesia in children for cross-finger-flap division, the adipofascial flap was determined to be superior in the following specific groups: children, older patients, and patients with osteoarthritis and multiple defects of adjacent border digits.