Complex hand injuries are those that involve significant soft-tissue loss with variable exposure of bones and/or joints, lacerated tendons, and neurovascular structures. Management of these injuries is optimally accomplished through the restoration of thin, pliable, ideally sensate tissue with reliable vascularity and a gliding surface to facilitate restoration of motion after repair. Unfortunately, optimal restoration may require complex surgical reconstruction and/or staged surgical procedures. This article presents an overview of some of the more commonly used options available to the reconstructive surgeon willing to tackle these difficult clinical cases.