A reverse dorsalis pedis flap based on the proximal communicating bran
ch of the dorsalis pedis artery was successfully used to close distal
forefoot defects in two patients. The skin paddle was oriented transve
rsely across the ankle crease, allowing for direct closure of the flap
donor site. Both patients maintained full active ankle motion without
bowstringing of the dorsal foot tendons and did not require special f
ootwear. Both flaps maintained sensation to light touch and pinprick.
We believe that this flap offers a viable alternative when faced with
the challenge of a small soft-tissue defect requiring flap reconstruct
ion in the distal foot.