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Introduction: Since the KDPFC was first described by Behan et al. in 2003, there have been a number of publications about this technique with case series between 1 and 300 flaps, and some have described further modifications of the design of the flap. The flap design resembles the keystone of a Roman arch and is based on the angiosome concept. The flap is a perforator flap, but does not require microsurgical dissection or preparation of the perforators. The technique is efficient and relatively simple to perform. With a few exceptions, it can be performed anywhere on the body. Although there are a large number of publications, not much data has been published on the complications, limitations and disadvantages of the technique., Methods: This is a retrospective analysis of the outcomes of 35 patients who underwent keystone flap reconstruction for soft tissue defects over 36 months. The flap design followed the original KDPFC description. Flap selection was based on the requirements of each defect., Results: Thirty-six flap procedures were performed on 35 patients. The mean defect size was 21 cm 2 (range 2-100 cm 2 ). Delayed wound healing occurred in 12 patients and flap loss was observed in 4 patients. One patient required further surgical revision. The wounds of the remaining patients healed by secondary intention. Four out of 10 patients who were on anticoagulants had delayed wound healing, compared with 12 out of 25 who were not on anticoagulants. Seven of the 16 patients with delayed wound healing, including 3 patients with flap loss, had defects reconstructed on the very distal lower leg and foot., Discussion: The KDPFC is a valuable addition to the reconstructive armamentarium. Although delayed wound healing has been observed in some cases, this flap concept can replace other local or regional flaps, also in more complex situations. Care must be taken in patient selection and, in particular, in large defects and difficult topographical areas on the distal lower leg. In these situations, other reconstructive options may be more appropriate., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (© Georg Thieme Verlag KG Stuttgart · New York.)

Falls prove to be a significant problem in geriatrics. 5% of falls lead to fractures and 10% to soft tissue injuries. We examined retrospectively the rehabilitation course of 78 patients, who had been treated by us after falls leading to injury. Fractures of the neck of femur predominated with 57%, followed by other fractures of the lower limbs with 13%. The remainder of the falls with consequences of injury lead to fractures of other parts and soft tissue injuries. In 34% of the falls, the cause was estimated as predominantly intrinsic and in 11% as extrinsic. 19% of the falls were a mixture of extrinsic and intrinsic factors. In 36% of the cases the cause remained unknown. Before the fall occurred, 72% were independent, 26% needed help and 1 patients was in need of care. After finishing rehabilitation 54% were independent, 34% needed help and 11% were in need of care. 86% were able to return to their usual social surroundings. Rehabilitation after falls with consequences of injury goes beyond mere "orthopedic" treatment. To minimize the future risk of fall, a precise analysis of the cause of fall should be implemented. One should moreover try to optimize the environment to reduce the risk.