The keystone-design perforator-based flap for leg defects: a synthesis of philosophies

Abstract

Aim: The classical keystone-design flap, although elegantly employed for various trunk defects, has limited movement on the leg. This study aims to modify the keystone-design flaps for leg defects. Methods: A keystone-design flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. Results: It retains the unique advantages of both the perforator island flap concept as well as the keystone-design philosophy. Conclusion: The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.