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The keystone flap: expanding the dermatologic surgeon's armamentarium
Schapoor Hessam1, Michael Sand, Falk G Bechara
1Department of Dermatology, Venereology, and Allergology, St. Josef Hospital, Ruhr-University Bochum, Bochum, Germany.
Summary
The keystone flap, a plastic surgery technique, offers superior vascular supply and safety for soft tissue defects. It provides excellent aesthetic and functional outcomes, making it ideal for deep wounds where other methods fall short.
Area of Science:
- Plastic and Reconstructive Surgery
- Dermatologic Surgery
Background:
- The keystone flap is an established technique for soft tissue defect closure after skin tumor excision.
- It remains underutilized in dermatologic surgery despite its advantages.
- Compared to other flaps, it offers enhanced vascularity by preserving perforator vessels.
Purpose of the Study:
- To highlight the benefits and applications of the keystone flap in dermatologic surgery.
- To present the keystone flap as an effective alternative for complex soft tissue reconstruction.
Main Methods:
- Review of existing literature and author experience with the keystone flap technique.
- Comparison of keystone flap outcomes with alternative reconstructive methods.
Main Results:
- The keystone flap demonstrates superior vascular supply and hyperemia.
- It is associated with a low complication rate and high safety.
- The technique yields excellent aesthetic and functional results, preserving contour, color, and sensitivity.
Conclusions:
- The keystone flap is particularly suitable for deep defects involving exposed bone or tendons on extremities and trunk.
- It offers a reliable and effective reconstructive option, outperforming secondary intention healing, primary closure, and skin grafting in specific cases.
