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

Abstract

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.

Eczema of recipient and donor skin graft sites: Another example of “Ruocco's immunocompromised district”

“…Preservation of sensation is also significantly lower in STSG than in flaps (Dobbs et al, ). The presence of contractures in the severely traumatized area is probably contributing to locally disturbed immune function (Dobbs et al, ).…”

Radical treatment of axillary osmidrosis using the VERSAJET™ II Hydrosurgery System or traditional open excision: A prospective cohort study

“…Four aspects were evaluated, including hematoma, epidermal erosion, skin necrosis, and wound dehiscence. Six months after surgery, the patients were asked to return to the clinic for the evaluation of the effectiveness of the operation, including odor elimination, postoperative scarring, hair growth, and patient satisfaction …”

“…Six months after surgery, the patients were asked to return to the clinic for the evaluation of the effectiveness of the operation, including odor elimination, postoperative scarring, hair growth, and patient satisfaction. [14][15][16][17][18] Unpleasant odor after axillary osmidrosis treatment was clas-…”

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

“…To this end, we recently published our own cohort study comparing objective and patient reported assessments of skin grafts versus keystone flaps (OPRASK). 5 We feel that in an era of shared decision-making it is important to consider comparisons based on patient experiences alongside traditional clinical measures of reconstruction such as healing time or complication rate. From our own experience, we would recommend the use of patient reported outcome measures (PROMs) in such studies.PROMs are standardized, validated questionnaires that are completed by patients and capture one or more aspects of their health and wellbeing.…”

“…7 In our study we found that both general health-related quality of life, as measured using the EuroQol 5 dimension scale (EQ-5D-5L), and disease-specific quality of life, measured using the Patient and Observer Scar Assessment Scale (POSAS), were higher in those who underwent keystone flap reconstruction compared to skin grafting. 5 We thank the authors for their contribution to the important area of skin cancer reconstruction and would advocate further studies comparing reconstructive options using PROMs as a primary outcome measure.…”