Abstract: [Objective] To introduce the surgical and therapeutic techniques and preliminary clinical results of keystone design perforator flap for repairing small wounds. [Methods] 26 patients with small wounds in the lower leg or foot and ankle were treated with keystone design perforator flap. Trim the wound to an oval shape, and its long axis is parallel to the longitudinal axis of the limb, and design the flap on one side of the wound. The short bottom edge is the curved edge of the wound, and the long bottom edge is parallel to the short bottom edge. The top angle on both sides of the short bottom edge extends 90 degrees to the long bottom edge, while 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 flap along the design line, separate the skin and fascia tissue, push the skin flap to the wound surface and layer by layer suture, and directly suture or graft the donor area. [Results] All patients were successfully operated on without serious complications, and the flaps survived well. In the early stage, there were 4 cases of flap swelling, 1 case of flap edge necrosis, 3 cases of incision dehiscence, and 2 cases of pain deficiency. All patients were followed up for 12 to 30 months, with an average of (22.92±6.31) months. At the last follow-up, the texture and color of the flap were similar to the surrounding tissue, and the sensory rating of the flap was significantly improved (P<0.05), while the VAS score was significantly reduced (P<0.05). According to the AOFAS score, 14 cases were excellent and 10 cases were good, with an excellent and good rate of 92.3%. [Conclusion] The keystone design perforator flap can better meet the appearance and function requirements, and is an effective way to repair small wounds in the lower leg or foot and ankle.