Perforator-based free flaps have been introduced for various kinds of reconstruction and resurfacing. The authors present their experience with the "superthin" latissimus dorsi perforator-based free flaps for hand resurfacing by preserving important donor structures such as motor nerve and muscle. The superthin flap with 5-7 mm of thickness could be elevated including skin and thin superficial adipose layer based on a single perforator of the back. These thin flaps could be used for resurfacing the moderate and large defects after the electrical burn, scar contracture release and crushing injuries. Nine clinical cases were performed with this superthin flap without flap necrosis or other serious complications. All these flaps were enough thin for the defects on the palm, wrist and thumb and therefore, early postoperative rehabilitation was effectively achieved. Volar or circumferential resurfacing of the thumb and palm resurfacing of the child could be available without any need of later debulking procedure. The dimension of the flap could be safely harvested up to 11 x 10 cm based on the single perforator and donor site was closed primarily without any functional deficit. Additional pedicle length of 3-5 cm was obtained through the tortuous intramuscular dissection and more proximal pedicle was taken for T anastomosis of the pedicle at recipient artery. We conclude that this superthin flap enough for hand resurfacing can be elevated from the back by dissecting based on a single perforator. These clinical trials can prove the real possibility of the superthin perforator-based free flap and widen its utility for the purpose of resurfacing.