The repair of a severely damaged hand requires not only a surgeon's skillful knowledge of the functional anatomy of the hand and the importance of its various parts and their place in the total function, but also experience in microsurgery. One's goal is to extensively save functionally important structures. Besides stabilizing the bone structure, microvascular measures to maintain blood circulation have priority. On the basis of three case studies each with different accident mechanisms, the problems of repairing a severely damaged hand and the results are described. When diagnosing such a severely damaged hand, one must evaluate the functional results that can be expected after repairing the hand in order to decide whether to keep it or to amputate and provide a prosthesis.