The keystone flap is a fascia-based island flap with two conjoined V-Y flaps. Here, we
report a case of successful treatment of a trochanter pressure sore patient with the
traditional keystone flap. A 50-year-old male patient visited our department with a 3×5
cm pressure sore (grade III) to the left of the greater trochanter that was covered with
eschar. Debridement was done and the defect size increased to 5×8 cm in an elliptical
shape. Doppler ultrasound was then used to locate the inferior gluteal artery perforator
near the wound. The keystone flap was designed to the medial side. The perforator based
keystone island flap covered the defect without resistance. The site remained clean, and
no dehiscence, infection, hematoma, or seroma developed. In general, greater trochanter
pressure sores are covered with a perforator based propeller flap or fascia lata flap.
However, these flaps have the risk of pedicle kinking and require a large operation site.
For the first time, we successfully applied the keystone flap to treat a greater trochanter
pressure sore patient. Our design was also favorable with the relaxation skin tension
lines. We conclude that the keystone flap including a perforator is a reliable option to
reconstruct trochanteric pressure sores.