Various types of flaps including local flaps, pedicle flaps and free flap have been used to reconstruct hand soft tissue defects, but each flaps have some limitation and disadvantages. The reverse posterior interosseous artery flap described by Zancolli and Angrigiani have some advantages : preserving the major artery of the hand, minimal donor site morbidity and thin skin. From May 1999 to May 2001, we reconstructed 18 cases of hand defects in industrial injury with reverse posterior interosseous artery flaps and partial distal part necrosis of flaps due to infection developed in a case but other 17 cases survived completely without any specific complication.