Keystone Flap for Large Posterior Neck Defect

Sun, Yuhang

doi:10.1007/s12262-015-1406-5

Cited by 7 publications

(6 citation statements)

References 8 publications

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“… 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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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: 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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“…Furthermore, performing minimal flap undermining of the flap margin while preserving the integrity of the central perforator hot spots, which is one of the inner conceptual features in KF, can guarantee stable flap perfusion and vascularity 4,9,11,12 . Despite these obvious merits of KF, few reports have focused on KF reconstruction of the posterior neck and lower occipital defects, and there has been only one report of a large posterior neck defect case without demonstration of follow-up clinical photographs, to the best of our knowledge 24 . However, we successfully performed KF reconstruction in 17 consecutive cases of posterior neck and lower occipital defects, and achieved good outcomes in all patients at their final follow-up.…”

Section: Discussionmentioning

confidence: 99%

Keystone Flaps for Coverage of Defects in the Posterior Neck and Lower Occipital Scalp: A Retrospective Clinical Study

Kong

Kim²,

Shin³

et al. 2021

Journal of Craniofacial Surgery

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The coverage of the posterior neck and lower occipital scalp defects should be approached carefully. Thick, stiff, and inelastic skin properties of these areas tend to make coverage of even small defects difficult. Herein, the authors present a retrospective review of our experience with posterior neck and lower occipital scalp reconstruction using the keystone flap (KF) and describe the expanding versatility of KF reconstruction. The medical records of 17 patients who underwent KF reconstruction to cover the posterior neck and lower occipital defect from April 2017 to May 2020 were reviewed. Clinical and operative data were collected. All defects were successfully covered with the KFs. The defect sizes ranged from 2.5 Â 3.5 cm to 6 Â 11 cm, and the flap sizes ranged from 3 Â 5.5 cm to 9 Â 18 cm. All flaps fully survived, although marginal maceration developed in one case; however, it healed with conservative management. The final results were favorable, and all patients were satisfied with their final outcomes. Consequently, the KF can be considered as a good reconstruction modality with few complications and provides an alternative to other reconstructive options for coverage of the posterior neck and lower occipital defects.

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“…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 . We first introduced this technique into China in 2010 and applied the flaps in repairs of the face, neck, trunk, and extremities, with good results 17 .…”

Section: Discussionmentioning

confidence: 99%

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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Keystone Flap for Large Posterior Neck Defect

Abstract: This article describes a method using local keystone flap to reconstruct posterior neck defect. This technique is easy and quick compared with the other techniques.

Cited by 7 publications

References 8 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

Keystone Flaps for Coverage of Defects in the Posterior Neck and Lower Occipital Scalp: A Retrospective Clinical Study

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

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