Applying the Keystone Design Perforator Island Flap Concept in a Variety of Anatomic Locations

Lanni, Michael A.; Kouwenberg, Emily Van; Yan, Alan Y.; Rezak, Kristen; Patel, Ashit

doi:10.1097/sap.0000000000000995

Cited by 30 publications

(39 citation statements)

References 18 publications

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“…The KDPIF was first reported in 2003 by Behan 8–10 . The KDPIF consolidates the vascular segment concept, forming its blood supply from various vascular networks, including muscle perforators, muscle septal perforators, and vessels from the deep fascia to the subcutaneous tissue and the dermis 11,12 . Many surgeons have used KDPIFs to repair wounds of different types at different areas, such as to reconstruct posterior neck tumors, 13 to cover defects on the limbs, 6 and to be an alternative for larger and more complex lesions 14–16 .…”

Section: Discussionmentioning

confidence: 93%

The use of modified keystone flap in periarticular or large superficial tumor resection surgery

Fang

Tang

et al. 2020

Journal of Surgical Oncology

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Background and Objectives: The keystone design perforator island flap (KDPIF) is often used to cover defects in reliable blood supply and similar skin patterns, but its mobility is limited, especially when the wound is large or occurs around joints. Here, we describe a modified KDPIF, boat-shaped flap. We added a V shape along the lateral arc, forming a V-Y flap on KDPIF's outer arc shapes like a sail. This paper also describes a clinical study to evaluate this method.Method: From September 2014 to March 2017, 31 patients were operated on using the boat-shaped flap in our department and were followed up annually with clinical evaluation. The wound locations included joints (n = 11), trunk (n = 18), and face (n = 2). Fifteen defects were ≥5 × 5 cm 2 .Results: After 6 to 24 months of follow-up, 29 patients had first-intention healing and were satisfied with the morphology and function. Secondary healing was observed in two patients, and the wounds were closed after dressing treatment for 2 weeks. Conclusion:The boat-shaped flap enhances the mobility and achieves strong resistance to tension. The modified curvilinear shape prevents the joint activity from being restricted, with visually concealed scars. It is particularly applicable for repairing large wounds and defects around joints. K E Y W O R D Sjoints, keystone design perforator island flap, mobility, repair, tension

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Section: Discussionmentioning

confidence: 93%

The use of modified keystone flap in periarticular or large superficial tumor resection surgery

Fang

Tang

et al. 2020

Journal of Surgical Oncology

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“…In a review of patients treated with keystone flaps in different body areas, Lanni et al . highlighted the technique's versatility . Modifications to the flap allow the technique to be used in places where the skin is tighter, such as the scalp or foot …”

Section: Demographic Data and Pathological Results For Each Patientmentioning

confidence: 99%

Keystone flap used on the legs: case series

et al. 2018

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“…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.…”

Section: Discussionmentioning

confidence: 99%

Successful application of modified keystone flaps following skin tumor ablation

et al. 2019

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Skin cancer and precancerous skin lesions cause significant soft-tissue defects following tumor ablation. Recently, keystone flaps have gained popularity due to their simplicity, versatility, and reliability.We evaluated the efficacy of modified keystone flaps for soft-tissue reconstruction following skin tumor ablation in 2 medical centers.We reviewed the medical records of patients who received modified keystone flaps following the removal of skin tumors from January 2017 to December 2017. The diagnosis, site, flap size, and complications were recorded.Forty-one modified keystone flaps were evaluated, and the wound dimensions ranged from 1 cm × 1 cm to 18 cm × 9.5 cm, with an average size of 9.8 cm × 6.4 cm. With our selection strategy, specific modified keystone flaps were designed for the soft-tissue defects. The flap dimensions ranged from 2.2 cm × 1 cm to 26 cm × 10 cm, with an average size of 14.3 cm × 7.5 cm. Two patients developed minor wound dehiscence (4.9%), and 1 patient developed partial flap loss (2.4%), but all of these patients healed after local wound care without the need for surgical intervention.Our selection strategy for modified keystone flaps is a feasible and reliable option for reconstruction following skin tumor excision.

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Applying the Keystone Design Perforator Island Flap Concept in a Variety of Anatomic Locations

Cited by 30 publications

References 18 publications

The use of modified keystone flap in periarticular or large superficial tumor resection surgery

The use of modified keystone flap in periarticular or large superficial tumor resection surgery

Keystone flap used on the legs: case series

Successful application of modified keystone flaps following skin tumor ablation

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