Treatment of soft tissue defect on the distal of the big toe is challenging due to the lack of reliable options that can be used to create a local flap to cover the injured area. Following injury, soft tissue defects expose the structures, joints, tendons and bone. Even a small defect will become problematic if it is not managed appropriately. 

Conventional reconstructive options include:

• Split-thickness skin grafting
• Adipofascial turnover flap
• Distal flaps based on the dorsalis pedis and microvascular free tissue transfer.

All of these procedures come with risks including morbidity at the donor site, incomplete functional recovery, infection and poor cosmetic outcome.  In this article, we outline an original technique for reconstruction the distal of the big toe following soft tissue injury. The defect is covered with perforator flaps created from superficial branches of the medial plantar artery. This article describes the position of the flap and presents a technique that can be used to create the flap. A case series is also presented in which this technique has been applied.