Three cases of traumatic skin defect and two cases of secondary skin defect after releasing scar contractures on the dorsum or palm of the hand, except for the fingers and thumb, were successfully reconstructed with the use of microdissected thin anterolateral thigh perforator flaps. This particular type of reconstruction needs thin, small flap coverage with a reliable blood supply from a long vascular pedicle. Microdissection of the perforator enables the distribution of vessels towards the thin layer of adipose tissue to be identified and the vessel in the deep adipose layer to be used as an additional pedicle vessel. Therefore, a small and thin flap can be elevated accurately with a longer vascular pedicle than is possible with the conventional method of flap elevation.