Keystone flaps in coloured skin: Flap technology for the masses?

Area of Science:

• Plastic Surgery
• Dermatology
• Reconstructive Surgery

Background:

• Skin viscoelasticity differs between ethnic groups, potentially impacting flap viability.
• Keystone flaps have primarily been studied in Caucasian populations.
• The efficacy of Keystone flaps in non-Caucasian individuals remains largely unexplored.

Purpose of the Study:

• To evaluate the reconstructive potential of Keystone flaps in a coloured ethnic group.
• To review existing literature on Keystone flap applications in diverse skin types.
• To assess the outcomes and complications of Keystone flaps in patients with Fitzpatrick skin types 4 and 5.

Main Methods:

• Retrospective case series analysis of 55 consecutive Keystone flaps.
• Data collected included patient demographics, medical history, defect characteristics, and surgical outcomes.
• Evaluation focused on flap survival, complications, healing, and need for secondary procedures.

Main Results:

• The study included patients with Fitzpatrick skin types 4 and 5, with an average age of 35.73 years.
• Despite 60% of flaps having risk factors, the overall success rate was 96.36% (53/55 flaps).
• Only two flaps failed, and seven experienced complications, all managed successfully with good healing; skin grafts were required in only four cases.

Conclusions:

• Keystone flaps demonstrate an acceptable success rate for primary wound healing in coloured skin populations, even with less favorable biophysical properties.
• This technique offers good aesthetic results, potentially avoiding conventional local or microsurgical flaps, extensive operative time, and the need for skin grafts.
• The benefits of Keystone flaps are particularly relevant for coloured populations, offering advantages in resource-limited settings and for younger patients with challenging defects.