The objective of this chapter is to present a brief discussion on the skin and soft tissue cover in the hand. The coordination of the tissues requires a stable skeleton enclosed in a supple soft tissue cover to carry out the functions coherently. Soft tissue cover is needed for coverage of the raw area, exposed vital structures and secondary reconstruction. Restoration of optimal function, Prevention of secondary deformities and aesthetically acceptable are the primary goals of skin restoration. Primary closure is the simplest form of reconstruction when there is not much tissue loss. Skin graft has a wide role to play in the management of hand injuries where there is only skin loss. A detailed description on skin graft, local flaps, regional and distant flaps and latissimus dorsi flap have been presented in this chapter.