The results of hand reconstructions with posterior interosseous flap were studied in 10 children (4 males and 6 females) aged from 1 year to 13 years old. In 4 cases flap coverage was performed due to acquired posttraumatic hand deformity, in 6 cases reconstruction was assumed for congenital hand deformities. Combined procedures consisted of posterior interosseous flap coverage and other types of microsurgical reconstructions were suggested in all 10 patients. Preoperative color Doppler visualization of the posterior interosseous vessels was mandatory. All flaps were risen under 3.5-4.5X magnification. All flaps survived completely in 3 weeks postoperatively. There were not postoperative complications such as flap's arterial or venous insufficiency, deep infection, or posterior interosseous nerve palsy. Nearly whole group (9 of 10) of patients and/or their parents were satisfied with the esthetic view of the reconstructed hand and donor site of the forearm 1 year postoperatively.