Background: The modified keystone flap is a type of fasciocutaneous island flap, whose vascularization comes from the muscular perforating arterioles. There are several techniques, Behan described the original one and Moncrieff et al. Introduced a variation in the flap in 2008. Currently, a new modification to the technique is proposed, the boated-shape form, which consists of the addition of a new V-shaped design in the outer bow, improving the distribution of closure tension. We present our clinical experience and surgical results in the Dermatological Surgery Unit with these different techniques. Methods: A retrospective collected series of cutaneous carcinomas treated by MMS and repaired with the modified keystone flap was studied during the years 2013-2021 in our department Results: Twenty seven reconstructions were made for the modified keystone flap. Twenty four were made using the Behan technique, two using the Moncrieff technique, and one using the boat-shaped variant. The types of tumors treated were seventeen basal cell carcinomas, nine squamous cell carcinomas, and one keratoacanthoma. The location of the tumors was seventeen in the lower limbs, five in the upper limbs, four in the back and one in the face. Most of the patients did not present major complications. Conclusions: The modified keystone flap is a good surgical repair option for use in areas of poor skin where repair of the surgical defect with a simple closure is not possible or when a graft does not have good aesthetic results.