Extended experience and modifications in the design and concepts of the keystone design island flap

This paper describes modifications to the design of the keystone design island flap for the reconstruction of oncological defects. In particular, the paper outlines a spectrum of modifications to the design that permit the design to be tailored to a broad range of reconstructive needs, factoring in the anatomical location of the soft tissue defect and the quality of the integument in that locality. The biomechanics of the flap are also discussed in detail. (C) 2009 Published by Elsevier Ltd on behalf of British Association of Plastic, Reconstructive and Aesthetic Surgeons.