The authors present four clinical cases of soft tissue defects affecting the hand and discuss various surgical management options available. These cases include a dorsal hand wound, thumb pulp defect, first webspace defect and a volar finger defect. For each case the authors provide a generalised overview of the defect type, discuss the goals of reconstruction and then list the surgical treatment modalities. They expand upon this by giving a detailed description of two surgical reconstruction options for each case; one regular well-established method of reconstruction and another relatively unconventional option. The authors cover technical considerations for each method and state their preferred choice between the two options and justify their reasons in making this decision. This article and the case illustrations included provide a good overview and discussion of relatively common traumatic hand defects but is limited by only discussing two of the surgical options available for each case.