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Background: Covering a small defect on the anterior lower leg is challenging because less soft tissue is available. This study presents the application of a keystone flap (KF) with omega variation (OV) and Sydney melanoma unit modification (SMUM) for small- and moderatesized pretibial defects.Methods: This study included a series of six cases of anterior lower leg defect reconstruction with OV and SMUM KF technique by a single surgeon between December 2017 and June 2020. Records and photographs of the patients were collected and analyzed.Results: The defects’ sizes ranged from 1.5×2.5 to 6×8 cm. All defects were covered with OV KF, SMUM KF, or OV SMUM KF based on the hotspots of surrounding perforators. The flap sizes varied from 3×6 to 8×17 cm. Moreover, all flaps were completely viable. A marginal maceration developed in one case, which was mended with conservative dressing. Outcomes were favorable in all patients during the average follow-up period of 4.83±1.17 months.Conclusion: This study successfully covered small- and moderate-sized anterior lower leg defects with OV and SMUM KF. We therefore suggest the OV and SMUM KF techniques as good alternative modalities for anterior lower leg reconstruction.

Keystone Flap with Omega Variation and Sydney Melanoma Unit Modification to Cover Small- and Moderate-Sized Defects in the Anterior Lower Leg