The free tissue transfer has been accepted with great enthusiasm by surgeons doing upper extremity reconstruction. Not only is it useful for coverage problems and bone reconstruction, but it provides a unique reconstructive capability when functioning musculature has been lost and digits amputated. The toe and partial toe reconstruction have become the mainstay of thumb reconstruction. For patients who have lost the flexor muscle compartment, functioning muscle transplantation provides an excellent replacement of their missing musculature. A major advantage of a free tissue transfer for coverage is that it allows early hand mobilization and hand elevation.