Although various local flaps are available for hand reconstruction, achieving satisfactory reconstruction of palmar defects of the hand remains a challenge. The consensus among plastic surgeons is that, when possible, like should be replaced with like. Furthermore, the palmar aspects of the thumb and index finger are functionally critical areas of the hand. Therefore, although palmar skin is treasured, its use to treat palmar defects of the thumb and index finger can be justified. The radial midpalmar (perforator) flap is a perforator based flap harvested from the radial aspect of the midpalm and based on perforators from the terminal branch of the superficial palmar arch, which connected to the princeps pollicis artery and/or the radial palmar digital artery of the index finger. This flap offers acceptable functional and cosmetic outcomes with respect to elasticity, durability, skin color and texture, and sensation for the reconstruction of extensive palmar defects of the thumb and index finger. In this presentation, I would like to discuss some issues about the radial midpalmar (perforator) flap.

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