PURPOSE: Soft tissue defect of the hand, which cannot be covered with skin graft or local flap, is usually reconstructed using a free flap. Temporoparietal fascial free flap is one of the best alternatives for functional reconstruction of the hand with exposed tendons, bones, and joints. MATERIALS AND METHODS: We have experienced four cases of reconstruction using a temporoparietal fascial flap with a skin graft and followed up for 20 years. We conducted a retrospective review of the patients' clinical charts and photos. RESULTS: At the time of initial injury, the average age of patients was 50.3 (39~62) years. The radial artery was used for reconstruction of the dorsal side of the hand, whereas the ulnar artery was used for that of the volar side of the wrist. Short term complication such as skin graft loss and donor site alopecia occurred. However, during the long term follow-up period, no change of flap volume was noted, and full range of motion in the adjacent joint was maintained. In addition, hyperpigmentation of the grafted skin on the flap disappeared gradually. CONCLUSION: Selection of the optimal flap is important for reconstruction of the hand without functional limitation. We obtained satisfactory soft tissue coverage and functional outcomes using a temporoparietal fascial free flap and followed up for 20 years.