Introduction: The term 'mangled hand' encompasses a spectrum of tissue damage involving bones, nerves, tendons, and soft tissues that necessitate formal composite reconstruction. From historical amputation to modern technology, hand salvage surgery continues to recreate lost anatomy and function. This presentation will explore navigational challenges in managing the mangled hand and share experiences using a range of autologous bone reconstructions. Furthermore, it will explore the application of virtual surgical planning (VSP) in the mangled hand. Methods: A retrospective review of seven cases involving mangled hands across two institutions within the last decade was conducted. Each case presented a unique challenge with a distinctive reconstruction, with and without the use of VSP. Data, including reconstruction technique, number of operations, length of operation, and the use of VSP, were collected. Results: Replantation included bilateral multiple digit repairs and a toe-to-thumb transfer. Metacarpal reconstruction included the use of autologous bone flaps from the fibula, medial femoral condyle, and the deep circumflex iliac artery flap. The median number of reconstructive procedures, follow up and length of surgery was 7.3 per patient, 34 months, and 498 minutes respectively. Complications occurred in 83% of patients and the use of VSP was employed in 57% of cases. Conclusion: This presentation aims to dissect the multifaceted intricacies inherent in mangled hand cases. Furthermore, the authors explore the continuum of surgical strategies and observes the beneficial role of VSP in the post-acute care of these patients.