The Keystone Design Perforator Flap: A Flap to Simplify Complex Reconstructive Issues

<b>Background</b> The keystone design perforator island flap (KDPIF) was first described by Behan in 2003 as a pliable flap, suitable for all body areas thanks to its curvilinear shape, which made it apt to fit mostly all cutaneous defects. <b>Materials and Methods</b> In this article, we aim to share our experience using KDPIF for the reconstruction of different defects. A retrospective analysis of patients who underwent cutaneous excision after trauma or tumor resection and reconstruction with a KDPIF at our department from 2020 to 2023 was performed. Patients' characteristics, indications, and operative and postoperative details were analyzed. <b>Results</b> There was no complete flap loss. One patient experienced partial flap loss without exposure to major structures and needed skin grafting. <b>Conclusion</b> Mapping of the perforators makes the keystone flap even more manageable, with the possibility to safely stretch and modify its design according to individual necessities.