Hilgenfeldt first described a flap most likely supplied by the first dorsal metacarpal artery in his book published in 1950The flap was further developed by Holevich in 1963 as a neurotized racquet flap with branches from the superficial radial nerveHolevich described elevating an area of epidermis off dermis in association with the first dorsal metacarpal artery creating the handle of the “racquet.” In 1979 with a case series and cadaver study Foucher and Braun6 defined the anatomy for the first dorsal metacarpal artery that the prior flaps were presumably based on and eliminated the dermal component. This created the true island flap and decreased pedicle bulk.