The free instep flap for palmar and digital resurfacing.

The palmar and digital volar skin is unique because of its glabrous nature, texture and light colour in all races. Any defect on the palmar surface not suitable for a homodigital or thenar flap remains a challenge for reconstructive surgeons. Various skin flaps have been described in the literature for palmar resurfacing. They all provide wound cover and may even match the contour satisfactorily, however, the colour and texture mismatch compromises the aesthetics of reconstruction. In our experience, the free instep flap is a more appropriate choice for palmar and volar digital resurfacing. It provides glabrous, potentially sensate, hairless skin with a better colour and texture match compared to conventional pedicled or free flaps in all cases. This paper describes our refined flap raising technique, the possibility of a neurotisation and discusses the role of the free instep flap for idealised digital and palmar resurfacing. It can provide a truly cosmetic microsurgical reconstructive option.