The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

Guern, A. Le; Wiart, T.; Modiano, P.; Lebas, D.

doi:10.1016/j.annder.2021.04.006

Cited by 3 publications

(5 citation statements)

References 4 publications

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“… 21 With a keystone flap, only 4/25 patients encountered complications in lower limb skin cancer surgery. 22 In a study by Li et al, wounds covered with an acellular dermal matrix healed within 20 weeks. 23 Punch grafting is not a widely used method in dermatosurgery, but based on a recent trial, this simple technique could be especially usable in some locations, such as the scalp and legs, and may thus offer a simple alternative for FTSGs of the lower leg.…”

Section: Discussionmentioning

confidence: 99%

“…For example, for patients with acral lentiginous melanoma of the foot, SIH showed better functional and cosmetic outcomes compared to FTSG, although FTSGs healed faster 21 . With a keystone flap, only 4/25 patients encountered complications in lower limb skin cancer surgery 22 . In a study by Li et al, wounds covered with an acellular dermal matrix healed within 20 weeks 23 .…”

Section: Discussionmentioning

confidence: 99%

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An exploratory randomized clinical trial on negative pressure wound therapy for lower limb full‐thickness skin grafts of dermatosurgical patients

Lindholm,

Salminen,

Koskenmies

et al. 2024

International Wound Journal

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Full‐thickness skin graft (FTSG) reconstructions of lower limbs are especially prone to wound complications. Negative pressure wound therapy (NPWT) enhances wound healing, but no broad evidence exists if it promotes graft take of lower leg FTSGs. In this investigator‐initiated, prospective, randomised and controlled trial, 20 patients with ambulatory FTSG reconstruction for lower limb skin cancers were randomised for postoperative treatment with either NPWT, or conventional dressings. As outcomes, adherence of the skin graft 1 week postoperatively, any wound complications within 3 months, including ≥3 weeks delayed wound healing, and the number of additional postoperative visits were compared. In both groups, grafts adhered equally well (p = 0.47); 80% of NPWT‐treated and 100% of control group grafts adhered >90%. There was no significant difference in the number of postoperative complications/delayed wound healing (p = 0.65); 70% of patients in the NPWT and 50% in the control group developed a wound complication. Both groups had an equal number of patients with at least three additional control visits (p = 1.0). The study was discontinued after 20 patients were recruited, as no benefit from NPWT was seen. To conclude, the study showed no benefit from NPWT for lower limb FTSGs.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

An exploratory randomized clinical trial on negative pressure wound therapy for lower limb full‐thickness skin grafts of dermatosurgical patients

Lindholm,

Salminen,

Koskenmies

et al. 2024

International Wound Journal

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“…It is a perforator-based island flap that is applicable on all body parts and used as a reliant technique of soft tissue defect closure, avoiding more complex flap designs [ 4 , 5 ]. It shows better results and lower complication rates than skin grafts [ 6 , 7 ]. As there are four types (Behan’s Classification) of flap design, there are many possibilities for reconstruction [ 3 , 5 ].…”

Section: Discussionmentioning

confidence: 99%

Reconstruction of extensive thoracolumbar defect with perforator-based double Keystone Island flap

Mužar,

Eljuga,

Jaman

et al. 2023

Journal of Surgical Case Reports

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Sarcomas represent 1% of malignancies in adult population; thereby dermatofibrosarcoma protuberans is found in 1%–2% of all cases. A surgical approach in oncologic treatment is the standard of care; therefore, important is an extensive resection to achieve clear margins and prevent recurrence. Herein we report a case of recurrent dermatofibrosarcoma protuberans in the thoracolumbar region. As the adequate resection was to cause a huge defect, we have made a reconstruction plan for coverage, using a perforator-based double Keystone Island flap (Type III). The method was chosen as a reliant solution with low complication rates and without need for complex flap designs thereby giving good functional and esthetic results. Main aim of the case report was to show that Keystone Island flaps present a simple and technically straightforward method with low complication rates and good results.

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“…Using local flaps that depend only on advancement, rotation, or transposition motion has a high risk of the development of tension necrosis, surgical dehiscence, and prolonged healing time. 2,3 The keystone design island flap is a trapezoidal-shaped fasciocutaneous local flap supplied by perforating arteries that provides reliable and durable vascularity. 4 The flap consists of two conjoined VY island flaps that release the longitudinal tension and recruit more laxity within the flap, enabling easy advancement toward the defect.…”

Section: Introductionmentioning

confidence: 99%

“…However, the lack of tissue laxity in the surrounding skin and limited flap width to length ratio may prohibit the use of several local flaps. Using local flaps that depend only on advancement, rotation, or transposition motion has a high risk of the development of tension necrosis, surgical dehiscence, and prolonged healing time 2,3 …”

Section: Introductionmentioning

confidence: 99%

Customized reconstruction with rotation Hemi‐Keystone flap

Hifny

Park

2022

J of Cosmetic Dermatology

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Introduction The keystone perforator flap has become a versatile alternative for reconstruction of cutaneous defects of various etiologies and in all age groups. However, it demands a notable incision area proportional to defect size and is more prone to excessive tension during defect closure. We present a novel modified rotation Hemi‐keystone flap that reveals its excellence in flap survival. Methods Between March and December 2021, a retrospective chart review was conducted of 40 patients who received rotation Hemi‐keystone flap for coverage of cutaneous defects by a single surgeon. The primary outcome was successful flap survival. Results We performed a total of 45 modified rotation Hemi‐keystone flaps for reconstruction of cutaneous wound defects. The location of the wound defects was in the head and neck (38%), extremities (35.7%), and trunk (26.2%). The most common cause of wound defect is tumor resection (45.2%). The mean wound defect dimensions were 3.5 cm × 3 cm. The mean follow‐up time was 6 months. There were no significant complications, with only one patient (2.4%) having minor wound dehiscence, which was treated by local wound care. Conclusions The current series presents a simple, reliable, and versatile modification of the traditional keystone flap that minimizes morbidity at the reconstruction site along with improvement of flap mobility for successful reconstruction of cutaneous defects in a tension‐free manner. The favorable outcome of this technique contributes to the inclusion of the rotation Hemi‐keystone flap as an excellent surgical option in the reconstruction of various soft tissue defects.

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The keystone flap and its simplified version for malignant skin tumor defects of the lower limbs: A review of 25 cases

Cited by 3 publications

References 4 publications

An exploratory randomized clinical trial on negative pressure wound therapy for lower limb full‐thickness skin grafts of dermatosurgical patients

An exploratory randomized clinical trial on negative pressure wound therapy for lower limb full‐thickness skin grafts of dermatosurgical patients

Reconstruction of extensive thoracolumbar defect with perforator-based double Keystone Island flap

Customized reconstruction with rotation Hemi‐Keystone flap

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