An adipofascial flap distally based on the first dorsal metatarsal artery is described. This flap was used successfully in three cases with skin defects of the distal foot. The advantages of this flap are minimal donor site morbidity and its applicability for larger defects. The surgical technique is described, and indications, advantages, and disadvantages of the method are discussed and compared with the distally based first dorsal metatarsal artery fasciocutaneous flap. The reverse first dorsal metatarsal artery adipofascial flap offers a new solution for reconstruction of distal foot defects.