fig3

Figure 3. (A) The island instep flap based on the superficial branch of the medial plantar artery; (B) The superficial branch of the medial plantar artery (arrow) is identified as it emerges between the abductor hallucis and flexor digitorum muscles (not visualized in this picture) inferior to the deep fascia; (C) Transection of abductor hallucis, or elevation, from its origin and the artery is dissected to its origin to avoid constriction of the vascular pedicle and allow maximal arc of rotation and minimize tension. (D) Ligation of the deep branch (arrow) so as to allow for complete mobilization of the flap; (E and F) The abductor hallucis and the flexor digitorum brevis are imbricated over the tendon to provide an adequate wound bed for skin grafting or a dermal regenerative template; (G) Skin graft or temporization with synthetic grafting.