The instep free flap to resurface palmar defects of the hand.

Large and deep soft-tissue defects of the hand require adequate resurfacing by free or distant pedicle flaps. A free flap of suitable size corresponding to the extended palm defect may be harvested from the instep region without encroaching on the weight-bearing area. Following Gillies's concept that "losses must be replaced in kind," and taking into consideration all possibilities of a free-flap reconstruction of the hand, we can conclude that an innervated fasciocutaneous free instep flap provides normal contour, texture, and color and thus an optimal functional, aesthetic, and anatomic reconstruction of the palm with acceptable donor-site morbidity.