A novel modification of keystone flap for superficial defects repair

In 2003, Behan 1 Behan F.C. The Keystone Design Perforator Island Flap in reconstructive surgery. ANZ J Surg. 2003; 73: 112-120 Crossref PubMed Scopus (226) Google Scholar was the first to report the Keystone Design Perforator Island Flap (KDPIF). The KDPIF has the advantages of simple design, convenient operation, certain perforator blood supply, adjacent tissue, good appearance and nearby texture. Therefore, it has been widely applied to repairing skin soft tissue defects caused by trauma, tumor resection, and scars. 2 Shayan R. Behan F.C. Re: the "keystone concept': time for some science. ANZ J Surg. 2013; 83: 499-500 Google Scholar , 3 Behan F.C. Paddle A. Rozen W.M. et al. Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects. ANZ J Surg. 2013; 83: 942-947 Google Scholar However, the KDPIF has certain issues such as excessive tension, constraint on the closure of the donor area, 4 Rao A.L. Janna R.K. Keystone flap: versatile flap for reconstruction of limb defects. J Clin Diagn Res. 2015; 9: PC05-PC07 PubMed Google Scholar , 5 Hessam S. Sand M. Bechara F.G. The keystone flap: expanding the dermatologic surgeon's armamentarium. J Dtsch Dermatol Ges. 2015; 13: 70-72 Google Scholar and skin contractures due to straight line scars across the joints in repairing large-size defects of the trunk, the joints or other moving areas. To address these problems, on the base of KDFIP, we designed an extra V shape on the lateral curve of the flap. Because the whole appearance of the flap like a boat, we also called this modified KDPIF as a Boat-Shaped Flap. The added “V” like a sail is the key point to reduce the tension of the flap and the surrounding soft tissues.