Many developments have taken place in the area of distally based dorsal hand flaps since 1988. This paper reported these developments as well as our clinical experience and cadaveric studies. Thirty-three reverse dorsal metacarpal artery (RDMA) flaps, 11 reverse dorsal digital artery (RDDA) flaps and five extended RDMA flaps done in the Institute for Research and Rehabilitation of Hand, Stanley Hospital, Chennai, India during the period between 1996 and 2002 are reviewed. In our series, we used simple, composite, fasciocutaneous and adipofascial flaps, encountered 4% total loss and 6% partial loss. A series of injected cadaveric hands were studied in the Institute D'Anatomie de Paris. An important anatomical finding in this cadaveric study is the dorsal metacarpal artery terminating at the confluence of common digital artery branching into digital arteries proper to the neighbouring digits in all the eight hands dissected. We undertake a critical review of the literature, highlighting the sequence of developments in the knowledge of relevant anatomy and various flap designs as distally based dorsal hand flaps since their first popular report in 1990.