title: Modified keystone flap for extremity defects after Mohs surgery.
abstract: BACKGROUND
  When possible, surgery is the treatment of choice for cutaneous carcinomas, as it allows to us perform the anatomopathological study and control the surgical margins. Mohs micrographic surgery (MMS) controls 100% of the margins, maintains a larger amount of healthy tissue, and a fewer number of recurrences are seen. Large limb surgical defects after MMS are a challenge. Within the different kind of flaps, the keystone flap, which is a fasciocutaneous island advancement flap, is an option.
  
  
  METHODS
  A descriptive study was carried out on the extremity defects that occurred after MMS, which were reconstructed with the modified keystone type flap, during the years 2013-2014 in our department.
  
  
  RESULTS
  Six patients underwent reconstruction surgery with the modified keystone flap. The tumor types presented by the patients were four squamous cell carcinomas and two basal cell carcinomas. Locations of the repaired defects were three in the leg, two in the thigh, and one in the forearm. The average size of the repaired defects was 3.1 cm. The procedure was well tolerated in all cases. No complications were observed, such as postoperative bleeding, infection, or necrosis, or dehiscence of the suture.
  
  
  CONCLUSIONS
  The modified keystone flap has been very helpful for solving the limb defects of these six patients, although they were not compared with other types of reconstruction.
authors.affiliation: Dermatologic Surgery Unit, Department of Dermatology, Hospital de Clínicas, Montevideo, Uruguay. juliomagliano@gmail.com.
authors.forename: Julio
authors.identifier: http://orcid.org/0000-0003-2007-9871
authors.initials: J
authors.lastname: Magliano
authors.affiliation: Dermatologic Surgery Unit, Department of Dermatology, Hospital de Clínicas, Montevideo, Uruguay.
authors.forename: Sofia
authors.initials: S
authors.lastname: Falco
authors.affiliation: Dermatologic Surgery Unit, Department of Dermatology, Hospital de Clínicas, Montevideo, Uruguay.
authors.forename: Caroline
authors.initials: C
authors.lastname: Agorio
authors.affiliation: Dermatologic Surgery Unit, Department of Dermatology, Hospital de Clínicas, Montevideo, Uruguay.
authors.forename: Carlos
authors.initials: C
authors.lastname: Bazzano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000601:surgery*; D002294:Carcinoma, Squamous Cell / Q000601:surgery*; D005260:Female; D005542:Forearm; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps; D013848:Thigh; D058106:Wound Closure Techniques