Abstract
Aspects of the enigma of the keystone flap (KF) are challenged by the well thought out work of Donovan et al.1 The experimental design and its limitations are well described. One reservation on the experimental suturing protocol is that the apical suture on the flap can be a ‘pulley’ suture, a double bite producing much greater tension and closability of a majority of defects. That stretchability is related to closability can hardly be argued. That viability is maintained despite this in well designed KF is a matter of record.
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