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Reconstruction of anterior skin loss in all four fingers using a free medial plantar flap

the thumb, which was of adequate recipient length. The ulnar digital nerve was found to be too short. One of the flap veins was anastomosed to a dorsal thumb vein of similar calibre using a 1.5 mm coupler. Rather than using the second vein of the skin island of the flap, the proximal end of the SPBRA was anastomosed to another dorsal thumb vein, which was forcefully pulsatile on tourniquet release. This caused concern that the flap may become congested. A 1.5 mm coupler was used for this arteriovenous anastomosis as the artery was found to be thin and pliable enough for coupler anastomosis to the recipient vein. The patient had an uneventful recovery and was discharged 5 days later. In our experience with SPBRA flaps, there is no functional problem from taking skin in the palm. The palmar span of the hand is not an issue, and no tightness is experienced postoperatively when harvested with a width of 2–3 cm depending on hand span. The range of motion was unchanged for the hand after harvest of the flap, which makes this an ideal donor site. By utilizing the anastomoses of vessels around the base of the thumb, the reach of the pedicled SPBRA flap can be extended, and venous outflow may be augmented as required.