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Highlights • Keystone design perforator island flap (KPIF) has been developed by Behan in 1995. • KPIF seems to be a new innovative and useful solution after a wide vulvar excision. • We found that Key Stone technique is an extremely simple and effective solution. • KPIF seems to be associated minimal morbidity. • KPIF showed less risk of flaps necrosis and lower complications., Objective This study aimed to evaluate the application of the Keystone flap technique and the long-term results of vulvovaginal reconstruction after vulvar surgery. Methods This is the first case series describing the application of the Keystone perforator island flaps (KPIF) technique to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyzed in the follow up. Results Five patients were selected for the study: four underwent radical vulvectomy for squamous cell vulvar cancer, and one underwent vulvar wide excision for Paget disease followed by reconstruction with the Keystone flap technique. The defects were successfully covered by the Keystone flap technique in all patients. Conclusions Keystone flaps seem to be easy to design and elevate, and it offers rapid fasciocutaneous closure in wide vulvo-perineal defects with excellent long-term results.