Keystone design perforator island flap in facial defect reconstruction

Lim, Soo Yeon; Yoon, Chi Sun; Lee, Hyun Gun; Kim, Kyu Nam

doi:10.12998/wjcc.v8.i10.1832

Cited by 15 publications

(57 citation statements)

References 29 publications

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“…Furthermore, another modi ed keystone ap mentioned by Moncrieff et al was named SMU (Sydney Melanoma Unit) -modi cation KDPIF [13]. A skin bridge along the greater arc of the KDPIF was maintained in patients with the SMU-modi cation KDPIF, which allows additional vascularity, preserves subdermal lymphatics, and promotes wound healing [13,14]. In this study, 12 patients received the treatment of KDPIF (type IIA = 8 cases; SMU-modi cation KDPIF = 4 cases) for the ALT ap donor site defects (the mean width was 8.1 cm; range from 7 to 10 cm).…”

Section: Discussionmentioning

confidence: 99%

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Cai

Liu

et al. 2021

Preprint

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Purpose: With the development of microsurgical techniques, the anterolateral thigh (ALT) flap has been widely used in reconstruction of various soft-tissue defects. However, there were few studies focusing on the closure of the ALT flap donor site, especially when the width of the harvested ALT flap was more than 6 cm. The purpose of this study was to share our experience of using Keystone Design Perforator Island Flap (KDPIF) to repair the ALT flap donor site where can’t be closed without a skin graft.Method: A retrospective study was used to analyze 12 patients who underwent the reconstruction of the ALT flap donor site using KDPIF from February 2018 to December 2020. Demographics, flap characteristics, surgical technique, postoperative complications, Vancouver Scar Scale (VSS) score, and Scar Cosmesis Assessment and Rating (SCAR) score were statistically analyzed.Results: 12 patients (10 males, 2 females) with the mean age 47.5 years (range, 27-66 years) were included in this study. All ALT flap donor sites were closed by the KDPIF. The mean size of the harvested ALT flap (the donor site size) was 8.1 cm × 14.4 cm (range from 8.0 cm × 11.0 cm to 9.0 cm × 21.0 cm), and the mean size of keystone flap was 9.1 cm × 16.4 cm (range from 8.0 cm × 13.0 cm to 12.0 cm × 19.0 cm). At the mean follow-up of 8.3 months (range, 6-12 months), two patients suffered from the skin infection around the flap, which was controlled under the treatment of wound dressing change and oral antibiotics. Wound dehiscence, osteofascial compartment syndrome (OCS), venous return disorder, and skin necrosis were not presented in any patients. All patients were evaluated at the final follow-up with ASS core (mean, 6.7; range, 5-8) and SCAR core (mean, 7.3; range, 6-9).Conclusion: This study demonstrated that the KDPIF that can be used to close the ALT flap donor site primarily is an effective and alternative treatment for patients with a the width of the donor site more than 6 cm including the advantages of high survival rate, low morbidity, good aesthetics, and simple operation.

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Section: Discussionmentioning

confidence: 99%

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Cai

Liu

et al. 2021

Preprint

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“…Consequently, we tried to check and mark perforator hotspots around the defect using a handheld ultrasound Doppler device as much as possible, especially in larger defects. Both the size of the defect and laxity of surrounding tissue were considered when designing the flap [2,5,6]. The width of the flap was designed to be larger than that of the defect, and the flap center was located on the marked perforator hotspots [2,5,6].…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…OV KF was used to add rotational flap movement. The original defect was therefore closed in a fish mouth fashion [5][6][7]. SMUM KF involves the maintenance of a skin bridge along the greater KF arch [5,6,8].…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…The original defect was therefore closed in a fish mouth fashion [5][6][7]. SMUM KF involves the maintenance of a skin bridge along the greater KF arch [5,6,8]. Basically, we used the SMUM KF in case of either smaller defects or imprecise perforator hotspots found in Doppler tracing, and used the OV KF when there was need for further flap movement to achieve tensionless closure.…”

Section: Surgical Techniquesmentioning

confidence: 99%

“…Today, free-flap surgery is a valuable reconstructive tool for covering defects in the lower extremities, given recent advancements in microsurgical concepts and skills [2,3]. However, free-flap surgery requires several conditions, including skilled microsurgeons, the hospital's capacity to support microsurgical operation and care, and the patient's ability to bear microsurgery [2,[4][5][6]. This means that other reconstructive modalities (e.g., skin grafting and local flaps) are still useful in lower extremity reconstruction.…”

Section: Introductionmentioning

confidence: 99%

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Keystone Flap with Omega Variation and Sydney Melanoma Unit Modification to Cover Small- and Moderate-Sized Defects in the Anterior Lower Leg

Kong

Kim

2021

J Wound Manag Res

Self Cite

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Background: Covering a small defect on the anterior lower leg is challenging because less soft tissue is available. This study presents the application of a keystone flap (KF) with omega variation (OV) and Sydney melanoma unit modification (SMUM) for small- and moderatesized pretibial defects.Methods: This study included a series of six cases of anterior lower leg defect reconstruction with OV and SMUM KF technique by a single surgeon between December 2017 and June 2020. Records and photographs of the patients were collected and analyzed.Results: The defects’ sizes ranged from 1.5×2.5 to 6×8 cm. All defects were covered with OV KF, SMUM KF, or OV SMUM KF based on the hotspots of surrounding perforators. The flap sizes varied from 3×6 to 8×17 cm. Moreover, all flaps were completely viable. A marginal maceration developed in one case, which was mended with conservative dressing. Outcomes were favorable in all patients during the average follow-up period of 4.83±1.17 months.Conclusion: This study successfully covered small- and moderate-sized anterior lower leg defects with OV and SMUM KF. We therefore suggest the OV and SMUM KF techniques as good alternative modalities for anterior lower leg reconstruction.

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An esthetic, functional, and low‐invasive lower red lip reconstruction using a mucosal perforator flap: A case report

Yamakawa¹,

Suda

Hayashida

2023

Clinical Case Reports

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Keystone design perforator island flap in facial defect reconstruction

Cited by 15 publications

References 29 publications

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Keystone Design Perforator Island Flap for Closure of the Anterolateral Thigh Flap Donor Site: a Case Series and Our Experience

Keystone Flap with Omega Variation and Sydney Melanoma Unit Modification to Cover Small- and Moderate-Sized Defects in the Anterior Lower Leg

An esthetic, functional, and low‐invasive lower red lip reconstruction using a mucosal perforator flap: A case report

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