BACKGROUND: Restoration of hand function postextended radial forearm free flap (E-RFFF) is vital but challenging due to complex forearm anatomy and potential complications like reduced range of motion and sensory deficits. Traditional rehabilitation protocols often do not effectively address these issues. PURPOSE: This study aims to explore the effectiveness of a hand therapy protocol that incorporates early active motion to enhance recovery outcomes after E-RFFF. STUDY DESIGN: Case series. METHODS: The protocol was applied retrospectively to eight patients undergoing E-RFFF between 2022 and 2024, assessing variables such as edema, pain, range of motion, strength, and sensation at two postoperative follow-ups. RESULTS: Initial findings indicate the protocol facilitated improvements in thumb opposition, wrist movements, and forearm rotations with stable sensory outcomes. Pain management and edema control were effectively addressed, highlighting the protocol's comprehensive nature. There were no instances of flap failure among the patients. DISCUSSION: The approach centers on early active motion, including "Dart Thrower's Motion," tailored to individual recovery phases. This method showed promising results in enhancing function and reducing complications, suggesting potential modifications to standard post-E-RFFF care. CONCLUSIONS: The study suggests that integrating early active and patient-specific hand therapy post-E-RFFF can significantly improve outcomes, challenging the conventional reliance on more passive postsurgery practices. Future research should expand on these findings to refine and generalize the protocol.