Lower limb abnormalities are common after traumatic injury or treatment of infected lesions on the lower limbs. The keystone flap is a novel treatment for limb deformities. It is a simple, less timeconsuming, long-lasting, and easily repeatable method of reconstructing most limb abnormalities. The purpose of this paper is to investigate the utility of the keystone flap in the reconstruction of a variety of upper and lower limb deformities. Keywords: Keystone flap; Lower limb defects; Local island flaps.