The Keystone Design Perforator Flap: A Flap to Simplify Complex Reconstructive Issues

Background The keystone design perforator island flap (KDPIF) was first described by Behan in 2003 as a pliable flap, suitable for all body areas thanks to its curvilinear shape, which made it apt to fit mostly all cutaneous defects. Materials and Methods In this article, we aim to share our experience using KDPIF for the reconstruction of different defects. A retrospective analysis of patients who underwent cutaneous excision after trauma or tumor resection and reconstruction with a KDPIF at our department from 2020 to 2023 was performed. Patients' characteristics, indications, and operative and postoperative details were analyzed. Results There was no complete flap loss. One patient experienced partial flap loss without exposure to major structures and needed skin grafting. Conclusion Mapping of the perforators makes the keystone flap even more manageable, with the possibility to safely stretch and modify its design according to individual necessities.