The hand surgeon's familiarity with options for flexor tendon reconstruction is essential. Efforts at primary repair are not always successful nor are the conditions after injury necessarily conducive to primary coaptation of tendon ends. Single-stage and two-stage grafting, tenolysis, and pulley reconstruction are parts of the reconstructive surgeon's armamentarium. Future interventions of tissue engineering suggest the possibility of creating a theoretically endless supply of available donor material for use in tendon reconstruction.