Current concepts of instep island flap.

The durability of the instep island flap and the sequelae of the flap donor site were assessed. The average follow-up period for 13 patients was 3 years and 8 months. Flaps provided permanent durable reconstruction of the heel, if there was no scar in the flap preoperatively. Flaps with scar or free skin graft showed hyperkeratosis or fissure of the flap after transfer to the heel. Accordingly, conservative treatment, special shoes, or other surgical procedures should be considered for these patients. All flaps that were transferred as sensory flaps preserved light-touch cutaneous sensitivity and static 2-point discrimination within a measurable range. The sequelae due to the flap elevation were tenderness in the bifurcation of superficial branches from the common digital nerves and sensory disturbance of the forefoot. Indications and surgical techniques are discussed.