AbstractAbstract In plastic and reconstructive surgery, skin flaps are widely employed. Large wounds that cannot be closed with normal treatments are treated with skin flap surgery. Skin flap necrosis is a well-known postflap cover issue that can affect cosmetic outcomes and patient satisfaction. Variable occurrence rates and inconsistent related factors have been reported in many retrospective studies of this condition. Despite advances in technology, the rate of flap necrosis remains significant in daily procedures. In this case study, we aim to evaluate the efficacy and safety of Low level laser therapy preventing flap failure. Keywords: Keystone flap failure; Necrosis; Lowlevel laser therapy; LLLT. Introduction Skin flap necrosis is a well-known post-flap cover issue that can affect cosmetic outcomes and patient satisfaction. Variable occurrence rates and inconsistent related factors have been reported in many retrospective studies of this condition. Despite advances in technology, the rate of flap necrosis remains significant in daily procedures. There are many methods which are used to ensure flap survival, one of them and with very few data available is low-level laser therapy (LLLT). In this article we share our experience of using LLLT and aim to evaluate the efficacy and safety in preventing flap failure.