Meshed keystone flap: A last-step modification to reduce tension and cover a larger surface

Abstract

Reconstruction of large defects on the limbs after excision of cutaneous carcinomas can be very difficult. Poor skin elasticity, scarce vascularity, and a large number of tendons that cannot be left exposed are factors to keep in mind; occasionally, the wound bed characteristics are not optimal to ensure skin graft survival. The keystone flap is a fasciocutaneous flap irrigated by vascular perforators1 and is an alternative to skin grafts used to cover medium and large defects, although the latter sometimes cannot be closed without excessive tension and risk of necrosis or wound dehiscence.