LAUSR

The keystone perforator island flapwas first describedby Felix Behan in 2003 and is a well-used flap in the field of skin cancer medicine, especially for defects on the lower leg that cannot be closed primarily. The described modification to the keystone designwill reduce flap size, suture materials, time, and possibly complications by limiting the operative area and thereby limiting injury to normal tissue, in a process the author chooses to call “shrinking keystones.” A case series demonstrates the procedure andoutcomes achieved.