The development of the neurovascular islandflap by Littler in 19461 sparked a transition towardisland flaps and away from flaps with a cutaneousportion to the pedicle. Island flaps subsequentlywere developed based on numerous other vessels. In particular, the dorsum of the hand andthe dorsal metacarpal arteries were identified asdonors. The radial cutaneous branch also provided the possibility of sensory reconstruction