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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.

Keystone flaps in orthopaedic management of soft tissue defects