OBJECTIVE: To investigate the method of improving the vitality of skin graft on donor site of the great toe-nail skin flap. METHODS: From June 1982 to April 1998, 252 cases of the great toe-nail flaps with piece of phalangeal bone and 18 cases of the simple great toe-nail flap were repaired with thin skin graft and packed under proper pressure. The stitches were removed two weeks later in common situation. It should be postponed on split thickness or partial survival skin flap avoiding early mobilization. RESULTS: Sixty-six cases of skin graft were necrotic after operation. Among them, 38 cases needed second skin grafting and 28 cases were healed after changing dressing. The survival rate of skin grafting was obviously higher on phalangeal marrow surface than on periosteum of the naked phalange. Contracture of the skin graft after operation made the retained skin flap expanding from medial side to lateral side and covered the whole plantar surface of the great toe. CONCLUSION: The survival rate of the skin graft on donor foot is improved after adopting the improved measures on taking the flap from great toe and paying attention to skin graft planting and packing. Free flap grafting is advocated for repairing of the wound on donor area of the great toe nail flap.