title: Keystone flap: versatile flap for reconstruction of limb defects.
abstract: BACKGROUND
  There is always a constant search for a new solution to tackle defects in the limbs. The technique has to be simple, easily reproducible and performed within a short duration. The answer is keystone island flap keystone flap is a simple, less time consuming, durable and easily reproducible option to reconstruct most of the limb defects.
  
  
  OBJECTIVE
  The aim of this article is to study the usefulness of keystone flap in reconstruction of various upper and lower limb defects.
  
  
  METHODS
  This retrospective review involves study of 20 patients undergoing keystone flap reconstruction for various defects from 2012 to 2014. 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 y with an average of 38.75y. Among the defects, 10 were following trauma (50%), 5 were due to tumour resection (25%), 3 followed debridement of abscess (15%) and another 2 defects were due to surgical wound dehiscence (10%). The largest defect covered by this flap in our study measured 45 x 18 cm and the smallest defect was 8 x4 cm. The average intra-operative time was 45.5 min (range 20-90 min). Fourteen flaps were done to cover lower limb defects (70%), 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 d. All patients were followed until they achieved stable, healed wound.The overall success rate was 95%.
  
  
  CONCLUSIONS
  Keystone flap can be safely used to cover various limb defects with minimal pain, a sensate cover and excellent cosmetic outcome, minimizing the need for microsurgical techniques or prolonged operative time.
authors.affiliation: Assistant Professor, Department of Plastic Surgery, Father Muller Medical College , Mangalore, Karnataka, India .
authors.forename: Aravind L
authors.initials: AL
authors.lastname: Rao
authors.affiliation: Resident, Department of Surgery, Father Muller Medical College , Mangalore, Karnataka, India .
authors.forename: Rakesh K
authors.initials: RK
authors.lastname: Janna
keywords: Incision; Malignancy; Perforator flap; Reconstruction