Split-thickness plantar skin grafts for coverage in the hand and digits

The instep of the foot is an excellent donor site for split-thickness skin grafts to cover soft tissue defects of the palm and digits. The technique is described and three illustrative clinical cases are presented. The unique, specialized characteristics of plantar skin are described, emphasizing similarities to palmar skin. The indications for this technique are hyperpigmentation, hair growth, ulceration, hyperkeratosis, marginal scarring, or recurrent breakdown of a preexisting graft, but we have also employed it for primary reconstructions in selected circumstances. The instep graft provides ideal color and texture match and long durability for a palmar graft, with the added advantage of an inconspicuous donor site.