Abstract:[Objective] To introduce the surgical techniques and preliminary clinical results of keystone design perforator island flap(KDPIF) for repairing small wounds. [Methods] A total of 26 patients were treated with KDPIF for small wounds in the lower leg or foot andankle. After debridement, the wound was trimmed to an oval shape with long axis parallel to the longitudinal axis of the limb. The flap wasdesigned on one side of the wound, with short bottom edge of the curved wound edge and the long bottom edge parallel to the short bottomedge maintaining a ratio of 1∶1 to 1.5∶1 between the width of the flap and the maximum width of the wound. Cut the edge of the skin flapalong the design line, separate the skin and fascia tissue, push the skin flap to the wound and suture in layers, finally, close donor area bydirect suture. [Results] All patients were successfully operated on without serious complications, and got the flaps survived well, despite thefact that there were 4 cases of flap swelling, 1 case of flap edge necrosis, 3 cases of incision dehiscence, and 2 cases of pain deficiency inthe early stage. All patients were followed up for 12 to 30 months, with an average of (22.9±6.3) months. At the last follow-up, the textureand color of the flap were similar to the surrounding tissue. In addition, the sensory grade of the flap was significantly improved from S0/S1/S2/S3/＞S3 （2/8/10/3/3） before discharge to （0/2/3/6/15） at the latest follow up (P＜0.05), while the VAS score was significantly reduced from(4.6±1.9) to (0.8±0.4) accordingly (P＜0.05). According to the AOFAS score, 14 cases were excellent and 10 cases were good, with an excel-lent and good rate of 92.3%. [Conclusion] This keystone design perforator island flap can better meet the appearance and function require-ments, and is an effective way to repair small wounds in the lower leg or foot and ankle.