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The purpose of this study was to present the authors' 11-year clinical experience involving 154 cases of arterialized venous flaps for hand reconstruction.The authors classified the venous flaps based on their size and composition. According to their size, flaps smaller than 10 cm2 were classified as small (n = 48), flaps larger than 25 cm2 were classified as large (n = 42), and those in between were classified as medium (n = 64). Classified according to their composition, there were 88 cases (57.1 percent) of venous skin flaps, 28 cases (18.2 percent) of innervated venous flaps, 15 cases (9.7 percent) of tendocutaneous venous flaps, and 17 cases (11 percent) of conduit venous flaps to repair arterial defects. There were six cases (3.9 percent) of composite venous flaps.The success rate of the flap transfer was 98.1 percent. The incidence of partial flap necrosis was 5.2 percent. The mean number of included veins was 2.17 for a small flap, 2.60 for a medium-sized flap, and 4.07 for a large flap (p < 0.01). The mean area of flap necrosis was 45.0 percent, 31.67 percent, and 18.75 percent for small, medium, and large flaps, respectively (p = 0.807). In eight cases of innervated venous flaps, the average static two-point discrimination was 10 mm (range, 8 to 15 mm). In 12 cases of tendocutaneous venous flaps, active range of motion at the proximal interphalangeal, distal interphalangeal, and metacarpophalangeal joints was 60, 20, and 75 degrees, respectively.The authors conclude that the arterialized venous flap is a valuable and effective tool for reconstructing complex hand injuries and may have a more comprehensive set of indications.