A distally based median plantar flap.

The first metatarsophalangeal joint area is a very difficult one to reconstruct, needing skin that is thick, sensitive, and resistant to friction. Although the medial plantar island flap was initially described to resurface heel defects, we have used this flap as a cross-foot flap to recover the first metatarsophalangeal joint area. Its use has always required a second surgical procedure. To overcome this inconvenience, we describe the use of a flap based on the principle of reversing the direction of blood flow in a distal vascular pedicle to restore a defect of the anteromedial aspect of the foot. Good functional and aesthetic results were obtained.