The authors have used a posterior interosseous flap for resurfacing in 113 cases of hand injury during the past 13 years. Its main indications were complex hand trauma or burn injuries with large skin loss, either acute or postprimary. Flaps survived completely in 98 patients. Twelve patients had superficial necrosis of the distal part of the flap, which did not require additional surgical procedures. Three flaps were lost and alternative coverage was used. Six patients demonstrated paralysis of the motor branch to the extensor muscles of the wrist or fingers (generally to the extensor carpi ulnaris, the extensor digiti quinti, or the extensor pollicis longus). All recovered completely within 6 months. The donor area was closed directly in 3 to 4-cm-wide flaps, leaving an inconspicuous scar. Larger flaps required skin grafting. Donor site morbidity was minimal. Major anatomic variations precluding the use of the flap were encountered twice in this series.