This videotape shows a technique of "custom designing" a microvascular free flap. In this procedure, a vascular pedicle surrounded by a small amount of muscle is implanted into the tissue that is to be transferred. Two weeks later, a delay procedure is performed by incising partially around the flap. One week following this, the delay flap has been revascularized by the implanted pedicle and can be transferred as a conventional free flap. The videotape illustrates this technique being used to resurface a scar contracture over the anterior lower leg in a 39 year old woman.