By 1992-93 Jackson was enrolled in the Creative Writing program at Brown University and decided to take a class with George P. Landow, who in the late 1980s had begun to explore hypertext as an extension and proving ground of poststructuralist theory. Students in Landow's course were required to produce their seminar project as a hypertext. Brown had recently adopted Storyspace, the hypertext writing environment developed by Jay David Bolter, Michael Joyce, and John B. Smith, to replace their own Intermedia system, rendered unusable after Apple dropped support for the version of Unix on which it ran. The text Jackson produced in Storyspace was a meditation on gender, embodiment, textuality, and embodiment, using a strategy of intense cross-linking (possibly with links on nearly every word) to build a fabric of connections across passages of original and quoted material. Traces of this first version survive as the "Broken Accents" thread in the published version.
At some point in 1993, one of Jackson's teachers at Brown, probably either Landow or Robert Coover, showed her project to Mark Bernstein of Eastgate. Bernstein expressed immediate interest in publishing, though Jackson asked to defer, wanting to develop the work independently of its academic context. In particular, she decided to reconsider the over-abundance of links. She began a second draft by eliminating all links from the project, developing a new concept with discrete narrative and thematic threads in which links were used more sparingly and logically. As Jackson would write a little later on: "I see no reason why hypertext can't serve up an experience of satisfying closure not drastically different from that of reading a long and complicated novel, though it will do it differently" ("Stitch Bitch," 1998).
Eastgate published Patchwork Girl on 3.5-inch diskette for Windows and Macintosh in October, 1995, presenting the disk and auxiliary material in a card stock "folio" with design by Eric Cohen. At some point demand for Patchwork Girl exceeded the print run of the folio, so Eastgate shipped new copies in a shrink-wrapped package out of expediency. A second edition was issued in November, 2001 on CD-ROM, also for Windows and Macintosh, with new packaging. As operating systems outgrew its original software framework, Patchwork Girl became unreadable on many contemporary platforms, especially those running 64-bit systems. In the final quarter of 2014, Eastgate remedied this problem for the Macintosh, issuing an updated version on a removable solid-state drive connectable via Universal Serial Bus ("USB stick" or "thumb drive"). The USB edition contains a version of the hypertext compatible with Macintosh OS 10.7 and later, as well as all all previous versions of the work for Macintosh.
Critical reception of Patchwork Girl has been extensive and distinguished. Jackson's work is one of the most studied works of hypertext fiction and arguably the best appreciated. Michael Joyce discussed Jackson's work in "Nonce Upon Some Times," a crucial early attempt to position hypertext fiction vis-a-vis the literary mainstream, appearing in Modern Fiction Studies in 1997. In 1998, two of the most influential literary papers in the academic hypertext literature, Bernstein's "Patterns of Hypertext" and Marjorie Luesebrink's "The Moment in Hypertext," drew crucially on Jackson's text. In 1999, Robert Coover presented Patchwork Girl as the final and paradigmatic example in the early evolution of hypertext fiction, declaring it the last product of a "Golden Age." N. Katherine Hayles took up Patchwork Girl in 2000 in "Flickering Connectivities," an article that would become a key chapter in her study How We Became Posthuman. In 2010, Alice Bell included Patchwork Girl in a comprehensive reconsideration of hypertext fiction. Important articles about the work have also appeared in SubStance, Contemporary Literature, and other leading literary journals.