• Oliver Scheufler, Daniel Kalbermatten, and Gerhard Pierer.
• Department of Plastic, Reconstructive and Aesthetic Surgery, University Hospital of Basel, Basil, Switzerland. oscheufler@uhbs.ch
• Microsurgery. 2007 Jan 1; 27 (3): 174-80.

AbstractPedicled instep flaps are frequently used in weight-bearing plantar reconstruction, but may not be available after severe foot injuries. Although free instep flaps offer a viable option, they have scarcely been reported. A posttraumatic plantar forefoot defect was reconstructed with a sensate, instep free flap, because local flaps were not available and defect size did not require a distant free flap, and the current literature was reviewed for therapeutic options. The instep free flap yielded an excellent functional and aesthetic long-term result. In the literature, pedicled instep flaps are advocated for moderate size defects of the weight-bearing heel and sole, while free flaps from distant sites are preferred for large defects. Although skin-grafted muscle flaps and fasciocutaneous flaps yield similar results, reconstruction by like tissues appears favorable. We suggest the instep free flap for weight-bearing plantar foot reconstruction, when pedicled instep flaps are not available and distant free flaps are avoidable.(c) 2007 Wiley-Liss, Inc.

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