Eyelid reconstruction: expanding the applications of the keystone perforator island flap concept

Loh, Ian; Rozen, Warren M.; Behan, Felix; Crock, John

doi:10.1111/j.1445-2197.2012.06222.x

Cited by 17 publications

(8 citation statements)

References 4 publications

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“…The benefits of the keystone flap have been well documented for the reconstruction of defects in range of topographical areas, 5–7,9,11–13 although there is little objective or patient-reported outcome data comparing them to SSGs. This study aimed to generate pilot data to address this.…”

Section: Discussionmentioning

confidence: 99%

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Objective and Patient-reported Assessments of Skin Grafts and Keystone Flaps—A Pilot Retrospective Cohort Study

Dobbs

Jovic

Jessop

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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Background:The keystone perforator island flap provides a versatile form of reconstruction. Perceived benefits include better donor-recipient color match, less contour defect, and fewer complications. To date, there has been no high-quality evidence comparing keystone flaps to split-thickness skin grafts (SSG) from both a qualitative and quantitative point of view.Methods:The Objective and Patient Reported Assessments of Skin grafts versus Keystone flap cohort study compares keystone flaps with SSGs for the reconstruction of skin cancer defects. Patient-reported outcome measures were collected using the EuroQol 5 dimension scale and Patient and Observer Scar Assessment Scale (POSAS) questionnaires. Objective assessments of skin quality were assessed with the Courage and Khazaka system. Cost analysis was also performed.Results:Thirty-eight patients were studied: 20 keystone flaps and 18 SSGs. The keystone group had higher EuroQol 5 dimension scale scores (keystone median = 1.0; SSG median = 0.832; P = 0.641) indicating better general quality of life and lower POSAS scores indicating better disease/condition specific quality of life (keystone mean = 27.7; SSG mean = 35.7; P = 0.323). Observer POSAS scores were significantly lower in the keystone group compared with the SSG group (keystone mean = 10.889; SSG mean = 17.313; P < 0.001). Preservation of sensation was significantly better in keystone flaps (P = 0.006). There was an average £158/$207 (15%) saving when performing a keystone flap.Conclusion:This pilot study demonstrates a number of possible benefits of keystone flaps over SSGs. The results demonstrate the need for further research comparing these reconstructive options. We propose a prospective, controlled study using the methods developed in this pilot study.

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Section: Discussionmentioning

confidence: 99%

“…4 Since the introduction of the keystone flap, 4 subtypes have been described, mainly based on the size of the defect and the extent of flap dissection (Table 1). 5 The keystone flap has been demonstrated to be a versatile form of head and neck, 6–9 nasal, 10 lower limb, 11,12 periarticular, 5 and postburn excision reconstruction. 13…”

Section: Introductionmentioning

confidence: 99%

Objective and Patient-reported Assessments of Skin Grafts and Keystone Flaps—A Pilot Retrospective Cohort Study

Dobbs

Jovic

Jessop

et al. 2018

Plastic and Reconstructive Surgery - Global Open

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“…In our study of five patients, the cosmetic outcomes were well-received and patient satisfaction was high. This parallels studies using keystone flaps in esthetically sensitive areas such as nasal and facial reconstruction ( 5 – 7 , 21 – 23 ). Despite their cosmetic appeal in matching the appearance of adjacent skin ( 3 ) a notable scar burden may still be associated with the use of these flaps, especially when under high tension, although this ameliorates with time (Figure 1 ).…”

Section: Discussionmentioning

confidence: 55%

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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“…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 .…”

Section: Discussionmentioning

confidence: 96%

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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Eyelid reconstruction: expanding the applications of the keystone perforator island flap concept

Cited by 17 publications

References 4 publications

Objective and Patient-reported Assessments of Skin Grafts and Keystone Flaps—A Pilot Retrospective Cohort Study

Objective and Patient-reported Assessments of Skin Grafts and Keystone Flaps—A Pilot Retrospective Cohort Study

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

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

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