The hand and upper extremities are one of the most common sites of complex trauma. Hand trauma causes both functional and psychological effects on patients. The most important aspects of hand trauma reconstruction are functionality, preserving the integrity of component parts, and low morbidity of donor sites in cases where grafting is necessary. This paper offers a re-examination of open hand fractures and soft tissue defects and new ways to reconsider the strategies to approach a mangled hand and upper extremity by using a “damage control” approach and a different perspective on donor sites