Replacing losses in kind: improved sensation following heel reconstruction using the free instep flap.

Two similar patients, with extensive defects of the heel treated by free tissue transfer of the contralateral instep, are discussed. Durable coverage and near normal static two-point discrimination were obtained in both. Improved results are attributed to the proximal interfascicular dissection of the medial plantar nerve and implantation into the posterior tibial nerve as the recipient. This flap may be transferred with only relatively minor donor-site complications. The contralateral instep free flap provides an ideal, durable, and sensate heel replacement, particularly when local tissues are unavailable.