The central area of the palm contains a triangular zone which is poorly vascularized. Because of the paucity of blood vessels, extensive undermining of this flap may invite delayed wound healing or frank necrosis. Appreciation of this important anatomical weakness has led the authors to adopt the principles of limited undermining of the skin and subcutaneous tissue of the palm or, following undermining of an extensive degree, the primary excision of nsomn-viable marginial tissue and coverage by skin grafts or pedicled flaps.