KDPIF, or Keystone Design Perforator Island Flap, is the main reconstructive tool available as a valid alternative to microsurgical procedures; its low complication rate is the key to its surgical success. This stepwise guide illustrates the technique's applications in orthopaedic reconstruction. The sections of the book cover the upper limb (including Dupuytren's disease), the lower limb defects (from groin to foot) and the rare vascular complications of the technique. The illustrations range from simple to complex cases in an easy-to-follow format, with audio files, acting as a supplementary tool to amplify and illustrate the technique to enhance the reader's experience and foster clear understanding. The basic design format for all Keystones are highlighted, all sitting within the dermatomal precincts. The KDPIF must contain a fascial base for lining and must be aligned within the dermatomal precincts.  This island outline is an essential pre-requisite for  its success. It is hypothesized that this islanding creates a sympathectomy effect resulting in hyperaemic blood flow which optimises healing: the KDPIF technique provides an alternative to microvascular procedures where the biggest drawback is tissue match. The KDPIF addresses this problem admirably with a low pain component, an excellent aesthetic match with a low vascular complication rate and executed in an expeditious manner with sensory recovery and resolution of oedema. Keystone Flap for Complex Orthopaedic Problems: Reconstructive Surgery with Audiovisual guidelines will be a valued companion to plastic and reconstructive surgeons and orthopaedic surgeons, that might find a valid alternative to  microsurgical techniques.