A systematic review of the keystone design perforator island flap in lower extremity defects

Abstract

Background:The keystone design perforator island flap is useful for the reconstruction of lower extremity defects. We performed a systematic review with the objective of identifying complication rates associated with using the keystone design perforator island flap to treat such defects.Methods:The MEDLINE, PubMed Central, Embase, and Cochrane databases were searched from January 2003 to August 2016 for articles describing keystone design perforator island flaps in lower extremities. The study selection was performed in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement.Results:Nine articles that involved a total of 282 keystone design perforator island flaps satisfied the inclusion criteria. In these articles, the most common cause of lower extremity defects was oncologic resection (89.0%). Most such defects were in the middle third of the lower leg (32.7%). Complications occurred in 9.6% of patients; these complications included partial flap loss (1.1%) and complete flap loss (0.7%).Conclusion:Given its high success rate and low technical complexity, if applicable, the keystone design perforator island flap should be the preferred approach for lower extremity reconstruction.

Comparison of keystone flaps and skin grafts for oncologic reconstruction: A retrospective review

“…Our average mobility restriction time and overall keystone complication rate (19%: 3/16) is in line with other truncal and extremity keystone series . Our lower extremity complication rate (43%: 3/7) was higher than the overall reported average of 9.6% . However, we believe this increased rate reflects the conservative inclusion of all complications, including presumed infections treated without culture confirmation and any small, self‐resolving dehiscence.…”

“…4,14,20 Our lower extremity complication rate (43%: 3/7) was higher than the overall reported average of 9.6%. 21 However, we believe this increased rate reflects the conservative inclusion of all complications, including presumed infections treated without culture confirmation and any small, self-resolving dehiscence. The increased complication rate may also reflect the refinement of the technique, as no wound dehiscence has occurred in keystones performed since January 2018.…”

Relaxed skin tension line-oriented keystone-designed perforator island flaps considering the facial aesthetic unit concept for the coverage of small to moderate facial defects

“…Various studies have described the use of KDPIF to cover full-thickness cutaneous defects in various anatomical locations including the face, neck, trunk, and extremities. [3,18–20]…”

Evolution of local perforator flaps in lower extremity reconstruction

“…The flap is designed so that each limb of the flap is 90 degrees from the longitudinal axis of the flap. This has been described throughout the literature for lower extremity defects mostly in the setting of oncologic reconstruction [26][27][28] with good outcomes. Limitations of the keystone flaps include limited advancement and no rotational movement.…”