Although the coverage of deep burn defects on the dorsal hand is quite complex and time-consuming, it can be accomplished by several techniques. Introduction of reverse flow island flaps obtained from the ipsilateral forearm or hand [1–4] has made the reconstruction easier, but even with the use of those flaps, the following serious problems often arise: (1) the sacrifice of major vessels of the arm and hand [5], (2) an unacceptable donor scar on the forearm or dorsal hand, and (3) the need for careful and complex dissection of vascular pedicles of small caliber. I believe these are the disadvantages of the reverse flow flaps. To overcome these disadvantages of the reverse flow skin flaps, adipofascial flap, which is fascial flap with overlying fatty tissue, is preferable to simple fascial flap because adipose tissue acts as an effective gliding surface of extensor tendons of the hand. We developed a radial artery perforator-based adipofascial flap for the repair of defects on the hand dorsum with minimal surgery [6]. In this chapter, we describe two cases in which radial artery perforator-based adipofascial flaps were successfully used.