Aesthetic reconstruction of retroauricular keloid: Creating a keystone flap from the mastoid‐helix area

Abstract

Advances in aesthetic rhinoplasty using conchal cartilage grafts have led to a high occurrence of retroauricular keloids. The purpose of this study is to introduce our surgical experiences using a keystone flap in retroauricular keloids following conchal cartilage grafts. The present study is a retrospective review of patients with pathologically confirmed retroauricular keloids following conchal cartilage grafts. These cases were surgically excised and we covered the defect with a keystone flap followed by one-time steroid injection at postoperative day 14 and silicone gel sheeting application for 3 months. Treatment outcome was recorded as recurrence or non-recurrence. In all patients, a follow-up period of minimum 12 months was required. Of these patients, 90.0% had successful treatment of their auricular keloids, whereas 10.0% had recurrences. The postoperative course was uneventful. In conclusion, our aesthetic reconstruction using a keystone flap created from the mastoid-helix area is a useful treatment strategy in terms of retroauricular keloids following conchal cartilage grafts.

Customized reconstruction with modified keystone flaps

“…Our published work review showed that traditional keystone flaps showed excellent outcome in various clinical settings. 3 However, some arguments and questions inevitably arose. One of the most debated issues is the topic of wound tension.…”

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

“…For small-to-moderate facial defects, several studies in the PubMed database primarily discussed nasal reconstructions followed by posterior auricular and medial canthal reconstructions. [6–8,21,22] Previous studies have described KDPIF as a single-stage reconstructive option that provided sound functional and aesthetic outcomes for nasal defects up to 2 cm in diameter, and partial thickness alar defects up to 1.5 cm in diameter. [6,7] Some of these studies have also reported that KDPIF nasal reconstructions were safe and reproducible even in the hands of inexperienced surgeons, albeit under guidance.…”

“…[3] KDPIF have grown in clinical applicability in various fields of reconstructive surgery in the past decade. [4–8] However, previous studies have only presented KDPIF reconstructions of facial defects in limited locations, such as large parotid defects and small-to-moderate nasal defects, but did not consider the facial aesthetic unit concept in detail. Therefore, to the best of our knowledge, we present the first report of, and a description of our experience with, relaxed skin tension line (RSTL)-oriented KDPIF reconstruction considering the facial aesthetic unit concept for the coverage of small-to-moderate facial defects in various regions.…”

Successful application of modified keystone flaps following skin tumor ablation

“…The clinical applications of the keystone flap have evolved over the past decade [8,9] to cover large defects in the trunk, [9,10] limbs, [11–13] perineum, [14,15] and head and neck. [16–19] In this study, 3 different types of modified keystone flaps were used to repair soft-tissue defects following skin tumor ablation. The selection strategy we applied for these 41 keystone flaps is feasible and has a high success rate for reconstruction.…”