Keystone Flap with Omega Variation and Sydney Melanoma Unit Modification to Cover Small-and Moderate-Sized Defects in the Anterior Lower Leg

Background: Covering a small defect on the anterior lower leg is challenging because less soft tissue is available. This study presents the application of a keystone flap (KF) with omega variation (OV) and Sydney melanoma unit modification (SMUM) for small-and moderate-sized pretibial defects. Methods: This study included a series of six cases of anterior lower leg defect reconstruction with OV and SMUM KF technique by a single surgeon between December 2017 and June 2020. Records and photographs of the patients were collected and analyzed. Results: The defects’ sizes ranged from 1.5×2.5 to 6×8 cm. All defects were covered with OV KF, SMUM KF, or OV SMUM KF based on the hotspots of surrounding perforators. The flap sizes varied from 3×6 to 8×17 cm. Moreover, all flaps were completely viable. A marginal maceration developed in one case, which was mended with conservative dressing. Outcomes were favorable in all patients during the average follow-up period of 4.83±1.17 months. Conclusion: This study successfully covered small-and moderate-sized anterior lower leg defects with OV and SMUM KF. We therefore suggest the OV and SMUM KF techniques as good alternative modalities for anterior lower leg reconstruction.