Modified retrograde-flow medial plantar island flap for reconstruction of distal dorsal forefoot defects--two case reports.

Soft tissue reconstruction of the distal forefoot and toes poses a difficult problem. Skin grafts are not suitable when deep structures are exposed. Local flaps are not available, particularly for defects of the toes. Free flaps are spared for larger defects. Medial plantar flap has been widely used for plantar defects, especially weight-bearing surface of the heel. Distally based retrograde-flow design of this flap allows the transfer of the pedicled flap distally and provides coverage of soft tissue over the metatarsal heads. In this report, we further modified the retrograde-flow medial plantar island flap to extend its use for distal dorsal forefoot defects. The technique and outcomes of two patients are presented.