Mutilating injuries include a wide and heterogeneous spectrum of clinical presentations, each being unique in terms of pattern of tissue damage, patient characteristics, and functional requirements. Understanding the principles of reconstruction of bone and soft tissues, a wide repertoire of surgical techniques, and the ability to plan the reconstructive journey leading to a functional hand are crucial. Management of these injuries involves several on-the-spot decisions by the surgeon. This article aims to equip the surgeon with the key principles and the bits of knowledge that are essential for effective planning and execution when dealing with such injuries.