In treating skin loss of the hand, the surgeon must be aware of the placement of skin and scars, the unique quality of palmar skin, the tendency of skin grafts to hyperpigment, the need for pain-free and well-padded amputation stumps that are free of painful neuromata and poorly padded phalangeal remnants. Skin grafts, palmar skin loss, regional flaps, distant flaps and local flaps are discussed. The histology and function characteristics of normal skin of the hand are reviewed.