Customized reconstruction with modified keystone flaps.

The reconstruction of soft tissue defects with a similar type of tissue and minimizing morbidities are important. Herein, we describe our surgical experience using customized reconstruction with a series of modified keystone flaps. We retrospectively reviewed data of 48 consecutive soft tissue reconstructions using modified keystone flaps between March and December 2017. Soft tissue reconstruction was performed and there was no major complication in the follow-up period. The dimensions of the wound defect ranged from 1 × 1 cm2 to 20 × 18 cm2 with a mean size of 4.7 × 3.5 cm2 , while the dimensions of the customized keystone design flap ranged from 2 × 1 cm2 to 23 × 19 cm2 with a mean size of 7.9 × 5.4 cm2 . Minor dehiscence in three cases (6%) and partial flap loss in one case (2%) were noticed. Two cases healed spontaneously and other two cases were surgically recovered. Due to its simplicity, reliability, versatility and minimal morbidity, our modified keystone flaps could be excellent surgical options in various soft tissue reconstructions.