Inclusion Criteria:  Patients with complex defects over the dorsal and palmar aspect of the wrist and the hand up to the proximal interphalangeal joint level, the whole thumb, and the first web space. Small to moderate hand defects resulting from post-traumatic raw areas, post-traumatic deformities, postburn deformities and scar, post tumor resection, and congenital hand deformity. Availability of a healthy donor site.  Exclusion Criteria:  Patients with a major uncontrollable medical illness. Chronic heavy smokers. Traumatic injury to the donor site. Complex defects of the hand beyond the PIP joint level.