Keystone flap for reconstruction of ulnar side defect of the hand: a case report

Soft tissue defects of the hand may present in various forms and are often challenging to treat. The goal of surgical hand reconstruction includes both functional and aesthetic aspects. The keystone-design perforator island flap is a multi-perforator advancement flap with a safe flap harvesting technique, reliable blood supply, minimal donor site morbidity, and a simple dissection process that obviates the need for microsurgical techniques. Our patient was an 85-year-old man with squamous cell carcinoma on the left-hand ulnar side. The patient had difficulty in ambulation and used the affected area of the hand to stand up. Thus, we planned reconstruction using an omega-variant type B keystone flap to further reduce tension during flap insetting and to provide sufficient padding that would protect against excessive pressure postoperatively. The flap and donor site were closed primarily, without any postoperative complications. The patient was satisfied with the outcome after 19-month follow-up.