Soft tissue reconstruction utilizing flaps after trauma, injury, or tumor resection in the hand is extremely difficult in the face of a patient with an abnormal Allen’s test. The standard reverse radial forearm flap will not work because sacrificing that artery can result in vascular compromise to the hand with subsequent necrosis. Reconstruction of the radial artery can be performed with the use of a vein graft, but this is time consuming and technically demanding. We report on an innovative reconstruction technique utilizing the distally based forearm fascial flap for hand reconstruction. The patient was a 53 year old right hand dominant female who was thought to have a cellular cutaneous fibrous histiocytoma based on biopsy results. Resection was carried out, but she needed soft tissue coverage of the defect. The patient had an abnormal Allen’s test, thus precluding the standard reverse radial forearm flap. The distal based forearm fascial flap is unique in that this flap is vascularized by the perforators of the distal radial artery. The radial artery itself is left completely intact. This flap is based along the axis of the radial artery and its pivot point is approximately 4 cm proximal to the radial styloid process. This flap is purely fascia based. Skin and muscle are left in their native beds. We used this flap to treat the patient who had wide resection of her volar hand tumor. Full thickness skin grafting was used to cover the fascial flap. The efficiency of this flap is that there is no need for micro-surgical technique. Overall we think this flap has several significant advantages over other flaps used to provide coverage about the hand. These include a constant and reliable blood supply that does not sacrifice any of the blood supply to the hand. Also, elevation of this flap is technically easier making the surgical time decreased compared to other techniques. The other major advantage is that micro-surgical techniques are not needed. We believe this type of flap holds great promise in the future, and it certainly should be the foremost flap in a patient with an abnormal Allen’s test that requires soft tissue reconstruction about the wrist and hand.