Keystone design perforator island flap for closure of myelomeningocele

Abstract

Whilst primary closure remains an option for myelomeningocele closure, primary repair of larger defects can lead to closure site tension, stretching of inelastic scar tissue and inadequate soft tissue cover. In this small series, we have demonstrated the use of keystone design perforator island flap closure as an alternative for larger and more complex lesions.

Evolving Concepts of Keystone Perforator Island Flaps (KPIF): Principles of Perforator Anatomy, Design Modifications, and Extended Clinical Applications

“…When designed over mobile muscle bellies (e.g., in the proximal thigh), release of the deep fascia even on one side can provide significant advancement subject to local tissue quality. 23 The keystone flap has demonstrated a growing diversity of clinical applications, 7-9 including coverage of large defects of the trunk, 10 limb, 13,14,21,26 groin, 23 perineum, 15 myelomeningocele, 27 and head and neck. 28 Previous modifications include a "yin yang" reconstruction, 29 including partial undermining and interdigitation of bilateral keystone flaps, 7 and the "omega variant," where both limbs of a single keystone are folded into a horseshoe shape.…”

Wound tension and ‘closability’ with keystone flaps, V‐Y flaps and primary closure: a study in fresh‐frozen cadavers

“…The keystone flap has been adopted in a number of centres internationally, but unlike other local flaps, there does not appear to be a clear biomechanical explanation for its apparent utility . A possible rationale for use of the keystone flap is the hypothesis that long‐axis relaxation of the island (EF in Fig.…”

Closure of a Large Thoracolumbar Myelomeningocele Using a Modified Bilateral Keystone Flap

“…In a case series of 3 patients, Gutman et al 4 safely and effectively demonstrated the use of keystone flaps for lumbosacral myelomeningocele closure. More recently, in a case series of 5 patients, Park et al 5 demonstrated the use of keystone flaps in lumbosacral myelomeningocele repair and concluded that it is an effective, reliable, and durable reconstructive option.…”