Avoiding Skin Grafts

Stone, Jill P.; Webb, Carmen; McKinnon, J. Gregory; Dawes, Jeffrey C.; McKenzie, C. David; Temple‐Oberle, Claire

doi:10.1097/prs.0000000000001449

Cited by 37 publications

(18 citation statements)

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“…Our average mobility restriction time and overall keystone complication rate (19%: 3/16) is in line with other truncal and extremity keystone series. 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.…”

Section: Discussioncontrasting

confidence: 61%

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

Darrach

Kokosis

Bridgham

et al. 2019

Journal of Surgical Oncology

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Background and Objectives Two common options for the closure of complex defects are local flaps and skin grafting. The keystone flap, a fasciocutaneous flap based on perforators, has demonstrated compelling ease of use, reproducibility, and low complication rates without requiring a distant donor site. Our objective for this study was to compare postoperative outcomes for keystone flaps and skin grafts in cancer resection. Methods A retrospective review was conducted of patients undergoing keystone flap closure or skin grafting for soft tissue defects resulting from cancer resection at a single institution from June 2017 to June 2018. Patient demographics, operative indications, length of stay, time to heal, and complications were reviewed. Results A total of 34 patients were identified having undergone either keystone reconstruction (n = 16) or skin graft (n = 18) after oncologic resection. Patients undergoing keystone flap reconstruction had significantly shorter mobility restriction and healing times. Length of hospital stay and overall complication rates were not significantly different. Conclusion The keystone flap is an adaptable tool that can safely be used for the coverage of complex defects with faster healing, shorter mobility restriction, and comparable complication rates to skin grafting without the need for a distant donor site.

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Section: Discussioncontrasting

confidence: 61%

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

Darrach

Kokosis

Bridgham

et al. 2019

Journal of Surgical Oncology

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“…There were 2 articles reporting more than 1 keystone flap on the same patient. [ 10 , 13 ] Multiple keystone flaps on the same patient or on the same leg might affect the complication rate. Stone et al [ 10 ] reported 32 keystone flaps in 30 patients, with 2 patients having bilateral lower leg flaps.…”

Section: Discussionmentioning

confidence: 99%

“…[ 10 , 13 ] Multiple keystone flaps on the same patient or on the same leg might affect the complication rate. Stone et al [ 10 ] reported 32 keystone flaps in 30 patients, with 2 patients having bilateral lower leg flaps. However, there was no information on the complication about these 2 patients with bilateral lower leg flaps.…”

Section: Discussionmentioning

confidence: 99%

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

Huang

Long

et al. 2017

Medicine

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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.

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“…Despite this, there is a sparsity of literature that concerns itself with the most appropriate means of periarticular wound closure. Although keystone flaps have been used previously for generic lower limb reconstruction ( 6 , 25 ) they have not been used widely in the popliteal fossa or periarticular areas to our knowledge. Alternatives to fasciocutaneous flaps such as the keystone include reconstruction with skin grafts, though these do not parallel the robust tissue coverage of local flaps and may exhibit high failure rates ( 16 ), particularly in mobile areas where graft adherence may be compromised.…”

Section: Discussionmentioning

confidence: 99%

“…It has been reported that keystone flaps around the elbow, knee, and ankle joints should be used cautiously due to reduced skin laxity and a risk of dehiscence ( 30 ), and previous studies have reported wound dehiscence following full flexion at the lumbosacral area ( 25 ). In our series, we did not immobilize the joints in plaster casts, but advise bulky dressings and enforced rest until wound checks were performed 2 weeks postoperatively.…”

Section: Discussionmentioning

confidence: 99%

The Use of Keystone Flaps in Periarticular Wound Closure: A Case Series

et al. 2017

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The Keystone perforator island flap (Keystone flap), is a Type A fasciocutaneous advancement flap, consisting of two V to Y advancement flaps. Skin cancer excision around joints presents a number of reconstructive challenges. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and withstand regional changes in tensile pressures. We report a single-surgeon series of five cases of periarticular keystone flap between 2014 and 2017. Data were collected from operation notes, clinical photography, histopathology, and outpatient clinic records. The indication for keystone flap was skin cancer in all cases (n = 5). The largest defect size post-excision in was 75 mm × 40 mm × 15 mm. All keystone flaps demonstrate a color and cosmetic appearance comparable to adjacent tissue. There were no major postoperative complications including flap failure or impaired range of joint movement in the follow up period. Superficial wound infection occurred postoperatively in one case. This is the first case series to discuss the use of keystone flaps in periarticular wound closure. Locoregional fasciocutaneous wound coverage offered by keystone flaps may alleviate the risks of graft failure, contour defects, and donor site morbidity associated with alternative reconstructive options, with good functional and cosmetic outcomes. We advocate their use as a robust reconstructive option in periarticular areas.

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Avoiding Skin Grafts

Abstract: Therapeutic, IV.

Cited by 37 publications

References 1 publication

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

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

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

The Use of Keystone Flaps in Periarticular Wound Closure: A Case Series

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