ObjectiveTo review the free flaps most frequently used in hand reconstruction and evaluate their results, advantages and complications. Material and methodsA total of 49 patients, with a mean age of 41 years old (25-57), underwent different microsurgical transfers for hand reconstruction between 2011 and 2014. The type of transfer performed depended on the location of the defects: a) 29 free flaps for finger reconstruction, b) 11 free transfers for hand coverage (dorsal coverage and first web space: 5 patients; volar hand defects: 2 patients; coverage of both regions of the hand at the same time: 4 patients, and c) 9 free vascularised bone transfers for non-unions (7 cases) and joint reconstructions (2 cases) in hand and fingers.The results were evaluated in terms of flap survival, complications, secondary procedures, and patient satisfaction. In addition, when fingertip reconstruction was involved, the two-point discrimination test was also assessed. ResultsThe survival rate was 100%. A secondary tenolysis was necessary in 5 cases, and another patient underwent two more surgeries to split the fingers (lateral arm used for volar coverage of the fingers). Good aesthetic and functional results and a high level of satisfaction were obtained. The means 2-PD in fingertip reconstruction was 9.1mm (8-11). ConclusionsIn our opinion, the use of free flaps for hand surgery reconstruction provides better outcomes, without sacrificing, in contrast to local flaps, other areas of the hand, with good aesthetic and functional results, as well as low donor site morbidity.