INTRODUCTION: Several flaps have been described for release of palmar contractures. The ideal flap for palmar region must have similar histologic features of the palmar area. Plantar skin has ideal tissue characteristics for reconstruction of this area.
AIM: In this study the venous structure of the non-weight bearing area and the arterialized venous instep flap was determined anatomically. Later, in the clinical part of the study, arterialized venous instep flap was used for palmar contracture release and the results were presented.
MATERIALS AND METHODS: The anatomical study was performed on 12 fresh foot from 6 cadavers. The arterialized venous instep flap was prepared from the non-weight bearing area of the foot including the skin, subcutaneous tissue and superficial venous plexus. In order to determine the venous structure dissection (6 feet) and injection-corrosion (6 feet) techniques were used. 
The clinical study was performed between January 2006 and June 2008 and 6 arterialized instep flaps were used for palmar contracture release. All flaps were harvested above the deep fascia including solely skin, subcutaneous fat and superficial venous plexus. At the plantar site of the flap, 2 or 3 veins were dissected long enough for arterial anastomosis and safenous vein were used for venous anastomosis. All anastomoses were performed end-to end fashion.
RESULTS: Dissection technique revealed that the flap has 7-12 and 4-6 veins at its plantar and superior edges respectively. Injection-corrosion technique showed that there are numerous anastomoses and interconnections between the veins of the flap.
At the clinical study, the median follow-up time was 9 (6-16) months. The flap dimensions were between 3x5 cm and 4x6 cm, and all flaps survived. Partial flap necrosis was observed in only one flap which healed with spontaneous epithelization. No debulking procedures were undertaken and all flaps were adapted well to the recipient site.
CONCLUSION: As a conclusion arterialized venous instep flap is a good alternative for release of palmar contractures. Because of the rich venous plexus of the flap, is quite reliable.