Various techniques for nail reconstruction have been reported until now; however, a simple one providing good esthetic results was difficult to find. Arterialized venous toenail flap is a free flap that includes the nail bed and matrix with a pedicle formed solely by the subcutaneous vein of the toe. The use of this flap is minimally invasive and easy, and the flap has a high survival rate. The mechanism of graft survival remains unknown given the nonphysiologic circulation. To the best of our knowledge, no studies have explained this mechanism with reference to detailed postoperative course. We herein present 2 cases of nail reconstruction performed using arterialized venous toenail flap. We analyzed the postoperative course in detail, which enabled us to postulate on the mechanism of graft survival.