Management Of Soft Tissue Defects Research Articles

ROLL OF LOCAL FLAP TECHNIQUE IN THE MANAGEMENT OF COMPOUND INJURIES OF LEG

Objective: The objective of this study was to study the feasibility of local flaps in management of soft-tissue defects with exposed fracture bone fragments in lower extremity (particularly the leg) due to trauma. Methods: The present study included 20 cases of traumatized lower extremity having a soft-tissue defect and an exposed bone with or without associated fractures. Study was conducted from January 1989 to August 1990. Local flaps provide a reliable single stage procedure for coverage of lower extremity soft-tissue defects. Distant flap provides good coverage but these procedures are long drown out and tedious. Only those cases were selected in which wound was found to be preferably, in the upper 1/3rd, middle 1/3rd and the upper most part of the lower third of the leg due to easy accessibility and placement of the flaps to these area. (As flaps can easily be transposed to these areas). All flaps, that is, Fasciocutaneous, Musculocutaneous, or local Muscle flaps were under taken as a delayed procedure after careful evaluation of traumatized limb, that is, repeated dressing, debridement and control of infection. Results: In this study, stable wound coverage was achieved in all patients. Most of the patients were in the age group of 18 to 42 (55%), of these 90% were male. The longest duration of follow-up was 14 months and shortest was 3 months. Excellent result were obtained in Muscle and Musculocutaneous flaps while good result was obtained in 10% cases of Fasciocutaneous flap. Conclusion: Stable coverage can be achieved by flap techniques using Fasciocutaneous Muscle of Musculocutaneous flaps. Coverage of exposed cartical bones, tendon and major vessels and adequate control of infection can be achieved by Muscle and Musculocutaneous flap in post traumatized limb. Fasciocutaneous flap (Ponten super flap) is very useful in repair of soft-tissue defect asit is a much simpler, easy to design and construct large flaps are safe due to good circulations, requires less time without any functional loss. Post-operative management is simple for both patient and staff.

Autologous menisci-cruciate ligament composite as a flap for soft tissue reconstruction following malignant bone tumor resection around the knee.

Despite significant improvements in oncological treatment, the management of soft tissue defects following malignant tumor resection remains challenging. We investigated whether autologous menisci and cruciate ligament, which are traditionally discarded, can be recycled as a supplemental flap in repairing soft tissue defects following malignant bone tumor resection and endoprosthetic reconstruction around the knee. Four knee specimens were dissected to provide a basis for the design of the menisci-cruciate ligament composite. Then, 40 patients with bone malignancies around the knee were enrolled and underwent reconstruction with free or vascularized composite following malignant tumor resection. The clinical, radiographic, and functional outcomes of this technique were evaluated in >1-year follow-up in each patient and compared with 87 patients who suffered from bone malignancies around the knee and were treated by limb salvage but without composite at our center over the same period. During the follow-up, a composite from one patient who underwent secondary amputation was retrieved and examined for in vivo remodeling. Fourteen patients were treated with vascularized composite transfer (10 distal femurs and 4 proximal tibias) and 26 patients with free composite transfer (19 distal femurs and 7 proximal tibias). The composite can be used to cover the area of soft tissue defect from 22 to 48.38 cm2 (34.67 ± 6.48 cm2 ). With contrast-enhanced ultrasound, peripheral rim healing and dotted blood flow signal at the side of anastomosis were detected on a patient 16 months after free composite transfer. Gross macroscopic remodeling and histopathologic analysis of a retrieved composite also indicated good healing with surrounding tissues and living cells in the composite. The complications and oncologic outcomes were comparable between study and control cohorts, but better Musculoskeletal Tumor Society (MSTS) score for patients reconstructed with composite (26.68 vs. 25.66, p =0.004). Of note, MSTS score was higher for patients reconstructed with composite at distal femur subdivision compared with the same subdivision in the control cohort (26.97 vs. 25.90, p =0.009). No statically significant difference was noted in complications, oncologic, and functional outcomes for patients reconstructed with free or vascularized composite. Autogenous menisci-cruciate ligament composite is an alternative option for soft tissue reconstruction. Either vascularized or free composite can be applied, depending on the size and localization of the defect.

Outcome of Knee Reconstruction using Saphenous Artery-Based Fasciocutaneous Flap: A retrospective study

Background and Aim: The soft tissue defects around the knee are common and represents a challenge for surgeons due to its complexity and desired outcome. Many reconstructive treatment options are available and flaps are recommended. The current study aimed to evaluate the outcome of using saphenous artery (SA)-based flaps for the management of soft tissue defects around the knee.
 Methodology: Files of 34 patients treated by SA-based flaps were reviewed for outcome and complications. Collected data included patient demographics, etiology, size, site and side of the defect and outcome (flap survival and complications) at the end of the 6th postoperative month.
 Results: There were 26 males and 8 females. Their age ranged from 18 to 45 years; the mean age was 33.18±6.58 years. The commonest etiology was posttraumatic (64.7%) then post-burn contracture (20.6%). The majority of defects were on the right side (82.4%). The maximum length of the defect ranged between 14 and 20 cm (mean ± SD were 16.56±1.62) while the maximum width ranged between 6 and 10 cm (mean ±SD were 8.59±1.05). The flap survival rate was 97.1%. The overall complications rate was 14.7%, distal flap necrosis reported for 5.9%, wound dehiscence for 2.9% and seroma for 5.9%. All treated conservatively, except that of distal flap necrosis which need reintervention.
 Conclusion: The saphenous artery-based fasciocutaneous flap is an effective, feasible and safe option for the management of soft tissue defects around the knee.

Management of soft tissue defects of the thumb

Hand surgery has undergone substantial changes in recent years, especially for reconstructive surgery techniques. We discuss the management of soft tissue defects of the thumb, discussing indications, and operative pearls and pitfalls. We cover non-operative treatment and local advancement flaps for small distal soft tissue defects and pedicled flaps for more significant defects. We also discuss composite vascularized free flaps such as second-toe neurocutaneous flaps and partial hallux transfer for compound defects or total amputations. This article aims to provide hand surgeons with an update on reconstructing an injured thumb.

Workhorse Flaps for Management of Soft Tissue Defects of the Dorsum of the Hand

Workhorse Flaps for Management of Soft Tissue Defects of the Dorsum of the Hand

Viability of Mesenchymal Stem Cells from Stromal Vascular Fraction to Tissue Engineering Scaffold Collagen, Calcium Alginate, Oxidized Cellulose, Gelatin, And Amnion Membrane (Primary Cell Culture in Vitro Study)

Introduction: Soft tissue engineering strategies targeting volume loss restoration has been developed as the current management of soft tissue defects. Important components of this method are cell sources, scaffold, and bioreactor. Adipose-derived mesenchymal stem cell (ADMSC) from a stromal vascular fraction (SVF) attached to scaffold and differentiated into defect tissue through cell communication. This study was aimed to investigate the viability of ADMSC from SVF combined with collagen, calcium alginate, oxidized cellulose, gelatin, and amnion membrane in vitro. Method: This true experimental done in the laboratory using 24 samples of SVF ADMSC that had been cryopreserved for 5 months and already get through the thawing process. Result: Based on the descriptive analysis with 4 repetition each group and control, gelatin shows average 90.928 and deviation standard 1,053, oxidized cellulose average 19,528 and deviation standard 2,543, collagen average 93,273 and deviation standard 1,195, calcium alginate average 92,953 and deviation standard 1,257, amnion membrane average 92,068 and deviation standard 2,467, control 95,995 and deviation standard 0,428. Conclusion: The use of gelatin, collagen, calcium alginate, and amnion membrane as scaffold show high viability results of ADMSC from SVF. Otherwise, oxidized cellulose scaffold has the lowest amount of viable cell. However, the most recommended scaffold material is amnion membrane because of the easiness of the production process, high availability, high potency of cell growth, and low cost.

Efficacy and safety of external tissue expansion technique in the treatment of soft tissue defects: a systematic review and meta-analysis of outcomes and complication rates.

Currently, various external tissue expansion devices are becoming widely used. Considering the scarcity of relevant application standards, this systematic review was performed to explore the effectiveness and safety of external tissue expansion techniques for the reconstruction of soft tissue defects. A systematic review and meta-analysis on the efficacy and safety of external tissue expansion technique was conducted. A comprehensive search was performed in the following electronic databases: PubMed/Medline, Embase, Cochrane Library (Wiley Online Library), and Web of Science. Studies reporting patients with soft tissue defects under the treatment of external tissue expansion technique were included. A total of 66 studies with 22 different types of external tissue expansion devices met the inclusion criteria. We performed a descriptive analysis of different kinds of devices. A single-arm meta-analysis was performed to evaluate the efficacy and safety of the external tissue expansion technique for different aetiologies. The pooled mean wound healing time among patients with defects after fasciotomy was 10.548days [95% confidence interval (CI) = 5.796-15.299]. The pooled median wound healing times of patients with defects after excisional surgery, trauma, chronic ulcers and abdominal defects were 11.218days (95% CI = 6.183-16.253), 11.561days (95% CI = 7.062-16.060), 15.956days (95% CI = 11.916-19.996) and 12.853 days (95% CI=9.444-16.227), respectively. The pooled wound healing rates of patients with defects after fasciotomy, excisional surgery, trauma, chronic ulcers and abdominal defects were 93.8% (95% CI=87.1-98.2%), 97.2% (95%CI=92.2-99.7%), 97.0% (95%CI=91.2-99.8%), 99.5% (95%CI=97.6-100%), and 96.8% (95%CI=79.2-100%), respectively. We performed a subgroup analysis in patients with diabetic ulcers and open abdominal wounds. The pooled median wound healing time of patients with diabetic ulcers was 11.730days (95% CI = 10.334-13.125). The pooled median wound healing time of patients with open abdomen defects was 48.810days (95% CI = 35.557-62.063) and the pooled successful healing rate was 68.8% (95% CI = 45.9-88.1%). A total of 1686 patients were included, 265 (15.7%) of whom experienced complications. The most common complication was dehiscence (n = 53, 3.14%). Our systematic review is the first to demonstrate the efficacy and safety of external tissue expansion in the management of soft tissue defects. However, we must interpret the meta-analysis results with caution considering the limitations of this review. Large-scale randomized controlled trials and long-term follow-up studies are still needed to confirm the effectiveness and evaluate the quality of healing.

Soft tissue reconstruction of the lower extremity in the pediatric population

Lower extremity defects are a source of significant functional and psychosocial morbidity for pediatric patients and require complex reconstructions to restore form and function. The advent of microsurgical reconstruction along with advances in wound care techniques and technologies have empowered reconstructive surgeons to perform limb salvage surgery in patients that would traditionally require amputation; however, the indications for performing reconstructive surgery for complicated cases are not ironclad. While this is the case, applying the principles of lower extremity reconstruction in adults to the pediatric population is often sufficient to achieve a satisfactory outcome. This overview discusses the evaluation and management of soft tissue defects of the leg in pediatric patients.

Clinical Application of Intrasite™ Hydrogel Dressing for the Management of Facial Gunshot Wounds With a Complex Soft Tissue Avulsion Defect

Study Design Case report Objective To present an alternative method to traditional iodoform gauze packing for the management of soft tissue defects. Hydrogel dressings are modern packing materials that can be used to hold negative space, provide moisture to the wound, and absorb wound exudates. Methods This report describes the case of a 28-year-old patient who suffered facial gunshot injuries, including an approximately 3-centimeter diameter avulsion of soft tissue at the posterior right cheek. After wound debridement and irrigation, Intrasite™ hydrogel was used as a wound dressing to fill the soft tissue defect. The injectable and slowly resorbable material was added as needed by the patient for eight weeks until wound healing. Results Wound healing by secondary intention was achieved with acceptable esthetic outcomes while avoiding traditional dressing changes. Conclusions Facial gunshot wounds present a multitude of challenges particularly when complex soft tissue avulsions are involved. The surgeon must adequately debride these wounds and manage soft tissue healing to prevent infection and ensure satisfactory aesthetic and functional outcomes. Long-term patient compliance is equally important; however, dressing changes are often difficult and uncomfortable for the patient. The use of an injectable hydrogel dressing facilitated soft tissue healing while affording greater comfort to the patient compared with traditional dressing changes, thus likely improving compliance during the crucial healing period.

The Role of Negative-Pressure Wound Therapy in Patients with Fracture-Related Infection: A Systematic Review and Critical Appraisal.

Introduction Fracture-related infection (FRI) is a severe musculoskeletal complication in orthopedic trauma surgery, causing challenges in bony and soft tissue management. Currently, negative-pressure wound therapy (NPWT) is often used as temporary coverage for traumatic and surgical wounds, also in cases of FRI. However, controversy exists about the impact of NPWT on the outcome in FRI, specifically on infection recurrence. Therefore, this systematic review qualitatively assesses the literature on the role of NPWT in the management of FRI. Methods A literature search of the PubMed, Embase, and Web of Science database was performed. Studies that reported on infection recurrence related to FRI management combined with NPWT were eligible for inclusion. Quality assessment was done using the PRISMA statement and the Newcastle-Ottawa Quality Assessment Scale. Results After screening and quality assessment of 775 unique identified records, eight articles could be included for qualitative synthesis. All eight studies reported on infection recurrence, which ranged from 2.8% to 34.9%. Six studies described wound healing time, varying from two to seven weeks. Four studies took repeated microbial swabs during subsequent vacuum dressing changes. One study reported newly detected pathogens in 23% of the included patients, and three studies did not find new pathogens. Conclusion This review provides an assessment of current literature on the role of NPWT in the management of soft tissue defects in patients with FRI. Due to the lack of uniformity in included studies, conclusions should be drawn with caution. Currently, there is no clear scientific evidence to support the use of NPWT as definitive treatment in FRI. At this stage, we can only recommend early soft tissue coverage (within days) with a local or free flap. NPWT may be safe for a few days as temporarily soft tissue coverage until definitive soft tissue management could be performed. However, comparative studies between NPWT and early wound closure in FRI patients are needed.

Gastrocnemius pedicled muscle flap for knee and upper tibia soft tissue reconstruction. A useful tool for the orthopaedic surgeon

Soft tissue defect coverage has always been a challenge for the orthopaedic surgeon. Over the last decades the surgery of flaps has completely changed the prognosis for large defects. The purpose of this study is to retrospectively review our experience with the gastrocnemius muscle as pedicled local flaps for reconstruction of knee and upper third of the tibia soft tissue defects.Twenty-seven patients underwent reconstruction of soft tissue defects around the knee using pedicled gastrocnemius muscle flaps. There were eighteen men and nine women ranged in with a mean age of 50.3 years. Medial gastrocnemius was used in 21 cases, and lateral gastrocnemius in 5 cases. In one patient, soleus and medial gastrocnemius were transferred simultaneously. All but one had at the same time split thickness skin graft for coverage of the muscle.All muscle flaps transferred were successful. There were no complications and all flaps survived completely without vascular compromise, satisfactory coverage of the defect, and good primary wound healing. There has been no recurrence of osteomyelitis. The donor sites healed perfectly with no remarkable resultant functional disability. A mean follow-up of 4.4 years revealed acceptable cosmetic results with high patient satisfaction.Our results indicate that the gastrocnemius muscle transfer is a useful technique for coverage of soft tissue defects in the upper tibia and around the knee in our orthopaedic practice. It is a reliable option for the coverage of exposed bone, the filling up of deep cavities and the treatment of bone infection. The principal advantage of a muscle flap is to bring a real blood supply to the recipient site and to improve the trophicity of the surrounding tissues. The pedicled muscle flap is our preference for the management of soft tissue defects around the knee, when no other procedure, apart from free flap is suitable. The pedicle flap is easier, quicker and with less complications than a free flap. Orthopaedic surgery has gained much from the use of island flap, however, it requires knowledge of the vascular anatomy and its variations promoted through cadaveric dissections and flap dissection courses.

Diagnosis and Treatment of Severe Fournier's Gangrene: Introduction of a Surgical Approach, Evaluation of Risk Factors, Microbiological Characteristics and Review of the Literature

Fournier's gangrene is a necrotising fasciitis type I occurring in the perineal and genital region. The disease expands progressively and still has poor outcome, especially in critical ill patients. This study's focus was placed on the evaluation of risk factors and comorbidities, on the bacteriological spectrum, laboratory analyses, mortality and the course according to the algorithmic approach. The medical records were reviewed of 10 patients with severe Fournier's gangrene from 2010 to 2019 who underwent intensive care therapy for at least 48 hours. Ten patients with Fournier's gangrene and sepsis and intensive therapy lasting at least 48 hours were recorded and analysed descriptively. The patient cohort consisted of six men and four women with a median age of 62 years (range 42 - 78 years). The median time between the onset of symptoms and hospitalisation was four days (range 3 - 5 days). The commonest aetiological event was a minor trauma. Predisposing factors included diabetes mellitus (30%) and overweight (80% BMI > 25). 90% of patients exhibited polymicrobial infection. All patients had systemic sepsis with SOFA-Score between 3 and 17 points. The mortality rate was 40%. Significant differences between surviving and deceased patients were shown by PCT, INR and aPTT (p < 0.05). Severe Fournier's gangrene continues to be a major challenge with a high mortality rate. Only rapid diagnosis, urgent extensive surgical debridement and intensive care therapy can lead to a favourable outcome in these critically ill patients. Vacuum-assisted closure can be successfully used in the management of soft-tissue defects.

Indications and functional outcome of the use of integra® dermal regeneration template for the management of traumatic soft tissue defects on dorsal hand, fingers and thumb

Few studies have been conducted to explore the utility of the Integra® dermal regeneration template (IDRT) combined with a delayed split-thickness skin graft (STSG) for reconstructing complex dorsal hand, digit, and thumb injuries. This study reports the indications and outcomes for 14 patients treated with this technique via a two-stage process. We retrospectively reviewed all patients treated by IDRT combined with STSG from May 2015 to October 2018. The inclusion criterion was traumatic or post-infectious soft tissue defects (STDs) of the dorsal hand, fingers, and thumb, not suitable for direct wound closure and requiring local, pedicle, or free flap reconstruction. After debridement, a two-stage procedure was applied, namely IDRT followed by STSG. Indications, functional outcomes, aesthetic results, complications, patient satisfaction, and the STSG take rate were evaluated over a 36-month follow-up using standardised instruments. A total of 14 patients with 15 reconstructions (average age = 48years) were included. The dominant hand was involved in 50% of cases. Dorsal STDs involved the hand, fingers, thumb, and hand and thumb in 7, 3, 2 and 2 cases, respectively. The mean STD size was 35cm2 (range: 3-150cm2). The wound was associated with exposed tendons (without peritenon), bone (without periosteum), and joints (without a capsule) in eight cases (57%). The IDRT/STSG take rate was 97%. The average Vancouver Scar Scale score was 2 (1-4). The 36-month follow-up demonstrated that IDRT is a safe and reliable technique that can be considered a viable alternative to flap reconstruction for the management of traumatic STDs in selected patients. The aesthetic outcomes are acceptable, functional recovery of the fingers is excellent, patient satisfaction is very high and the rate of complications is very low.

Microvascular free flap coverage for salvage of the infected total knee arthroplasty

The integrity of the soft tissue envelope is crucial for successful treatment of infected total knee arthroplasty (TKA). The purpose of this study was to evaluate the rate of limb salvage, infection control, and clinical function following microvascular free flap coverage for salvage of the infected TKA. We retrospectively reviewed 23 microvascular free tissue transfers for management of soft tissue defects in infected TKA. There were 16 men and seven women with a mean age of 61.2 years (39 to 81). The median number of procedures performed prior to soft tissue coverage was five (2 to 9) and all patients had failed at least one two-stage reimplantation procedure. Clinical outcomes were measured using the Knee Society Scoring system for pain and function. In all, one patient was lost to follow-up prior to 12 months. The remaining 22 patients were followed for a mean of 46 months (12 to 92). At latest follow-up, four patients (18%) had undergone amputation for failure of treatment and persistent infection. For the other 18 patients, 11 patients (50%) had maintained a knee prosthesis in place while seven patients had undergone resections for persistent infection but retained their limbs (32%). Reoperations were common following coverage and reimplantation. The median number of additional procedures was two (0 to 6). Clinical function was poor in patients who underwent reimplantation and retained a knee prosthesis following free flap coverage with a mean KSS score for pain and function of 44 (0 to 70) and 30 (0 to 65), respectively. All patients required an assistive device. Extensor mechanism problems and extensor lag requiring bracing were common following limb salvage and prosthesis reimplantation. Microvascular tissue transfer for management of infected TKA can be successful in limb salvage (82%) but clinical outcomes in salvaged limbs were poor. Cite this article: Bone Joint J 2020;102-B(6 Supple A):176-180.

Prevention of the Infected Fracture: Evidence-Based Strategies for Success!

There is a significant burden of disease associated with infected fractures, and their management is challenging. Prevention of infection after musculoskeletal trauma is essential because treatment of an established infection continues to be a major obstacle. Despite the need for evidence-based decision making, there is a lack of consensus around strategies for prevention and surgical management of the infected fracture. The current evidence for the prevention of the infected fracture is reviewed here with a focus on evidence for antibiotic therapy and debridement, the induced membrane technique, management of soft-tissue defects, patient optimization, and adjuncts to prevent infection.

The use of sural island musculo fasciocutaneous flap, in the management of chronic osteomyelitis of the tibia.

: The management of soft-tissue defects following surgery for chronic osteomyelitis of the tibia is challenging. It often requires complex reconstructive procedures, especially when the distal third of the tibia is involved. We present a relatively simple method of addressing these defects. : This study aims to report our experience with the use of the sural Island musculo fasciocutaneous flap in the management of osteomyelitis of the tibia. : Consecutive patients with osteomyelitis of the tibia requiring soft-tissue cover were managed using the sural Island musculo fasciocutaneous flap, and the outcome was analyzed. The study was prospective in nature. : There were 21 patients, 15 males and 6 females. Their ages ranged from 21 years to 62 years. Most (71%) were in the 3rd and 4th decades of life. Twelve patients had involvement of the distal third of the tibia, eight involved the middle third, while five patients had involvement of the proximal third. Most of the patients (17) developed osteomyelitis following open fractures of the tibia; thirteen of these were from road crashes and four from gunshot injuries. Four patients developed osteomyelitis through the hematogenous route. Flap sizes ranged from 8 × 7 cm to 16 × 11 cm. There was tip necrosis in 2 flaps and full survival in 19 flaps. The flaps with partial necrosis were managed by simple dressing. Fifteen patients (71%) had cessation of drainage within 4 weeks of surgery. Two patients presented with recurrence of infection within the period of follow-up. Mean follow-up period was 23 months. All donor sites were skin grafted primarily, with 95%-100% graft take. The sural Island musculo fasciocutaneous flap is a reliable source of richly vascularized soft tissue for the management of dead space and soft-tissue defects in chronic osteomyelitis of the tibia. It has the added advantage of providing sizeable tissue, with good reach to all segments of the tibia.

Sural Flap Use for the Treatment of Wounds With Underlying Osteomyelitis: Graft Size a Predictor in Outcome, a Systematic Review.

Therapeutic, Level III: Systematic review.

Comparative effectiveness study between negative pressure wound therapy and conventional wound dressing on perforator flap at the Chinese tertiary referral teaching hospital

BackgroundPerforator flap techniques with conventional wound dressing have being extensively used in the management of soft-tissue defects. However; the flap's survival rate is not always guaranteed and the wound healing time always long. The aim of this study was to investigate the clinical effectiveness use of a freshly transplanted perforator flap in conjunction with Vacuum-assisted closure (VAC) for better clinical outcomes. MethodsA prospective, randomized, effectiveness study comparing the clinical outcomes of VAC versus traditional wrap and bandages for the treatment of open wounds that required hospital admission and operative debridement using perforator flaps, was carried out from March 1, 2014 to March 31, 2016 at Wuhan University Zhongnan Hospital. Fifty-one eligible patients were randomized into two groups; study group (perforator flaps covered by VAC) and control group (perforator flaps covered by traditional wrap and bandages). The measured clinical endpoints included the time of the first post-operative dressing change, pain visual analogical scale, perforator flap infection rate, 95% perforator flap healing time and percentage of survived perforator flap. ResultsThere was no statistically significant difference in the demographic profiles in the two cohorts. There were statistically significant differences in the clinical endpoints in the two groups (p < 0.001; p < 0.05, Table 2). ConclusionsIn summary, VAC combining with perforator flap technique, can diminish accumulated exudation of the transferring flap, protect against postoperative infection, prolong the interval between perforator flap relocation and first postoperative dressing change, decrease pain during removal of dressing, increase perforator flap survival rate, and shorten wound healing time, with a good aesthetic outcome, a good mobility and a satisfactory therapeutic result.

Study on Management of Soft Tissue Defects in Upper and Lower Limbs

Study on Management of Soft Tissue Defects in Upper and Lower Limbs

Keystone flaps in orthopaedic management of soft tissue defects

Background: Soft tissue defects of the upper and lower limb pose a challenge to the orthopaedic and plastic surgeon. The technique has to be simple, easily reproducible and performed within a short duration. The answer is keystone island flap. Aim: The aim of this article is to study the usefulness of keystone flap in reconstruction of various upper and lower limb defects in orthopaedic soft tissue loss. Material and Methods: This retrospective review involves study of 20 patients undergoing keystone flap reconstruction for various defects of upper and lower limbs from 2014 to 2016. Patient demographic data, medical histories, comorbidities, surgical indications, defect characteristics and locations, hospitalization, complications and follow-up were evaluated and are presented as uncontrolled case series. Results: Ages of the patients were ranging from 18 to 65 years with an average of 38.75. Among the defects, 10 were following trauma (50 percent), 5 were due to bone tumour resection(25 percent), 3 followed debridement of osteomyelitis (15 percent) and another 2 defects were due to surgical wound dehiscence (10 percent). The largest defect covered by this flap in our study measured 45 X 18 cm and the smallest defect was 8X4 cm. The average intra-operative time was 45.5 minutes (range 20-90 minutes). 14 flaps were done to cover lower limb defects (70 percent), 4 for upper limb defects and 2 were for defects in the axilla. Partial flap necrosis was observed in one case. The average duration of hospital stay of patients was 3.45 days. All patients were followed until the wounds healed. The overall success rate was 95 percent.Conclusion: Keystone flap is an excellent method to cover various limb defects with excellent cosmetic outcome, minimal pain, a sensate cover and, minimizing the need for microsurgical techniques or prolonged operative time.