Keystone Flap: A Reconstructive Option for Lower Limb Defects

Lower Limb defects have been managed by different kinds of flaps. However, they also cause donor site morbidity as well as poor aesthetic outcome.The keystone island flap was described by Behan in 2003.] The keystone flap derives its name from its similarity to the architectural keystone piece that marks the central portion of the arch. It employs immediately adjacent skin and soft tissue that provides a good colour match in addition to reconstructing the contour of the defect, so providing a far superior cosmetic result.A prospective study was developed from October 2017 to December 2019 at SMS Hospital, Jaipur. In our experience, we have observed flap execution is easier over the trunk, gluteal region and thigh, but difficult over knee and distal leg due to deficient skin laxity in the lower leg. It is an excellent option for covering large defects over thigh where there is adequate tissue laxity.