A patient with malignant fibrous histiocytoma of the dorsum of the hand, managed with irradiation and wide local excision, is presented. Biopsy technique, the rationale for preoperative irradiation, and the details of extensor tendon reconstruction are discussed. Tendon grafts, rather than transfers, were used to reconstruct the extensor tendon defects. Although this approach is simple, little is known regarding the healing of irradiated tendons or the use of dynamic splinting protocols in this setting. Our patient experienced no difficulty with either tendon healing or early dynamic splinting and achieved an acceptable range of motion.