Avoiding Skin Grafts: The Keystone Flap in Cutaneous Defects

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Traditional methods for closing lower leg defects often involve skin grafting, which can lead to suboptimal aesthetic and functional outcomes.
• Fasciocutaneous perforator flaps offer an alternative for reconstruction, preserving underlying tissue viability.

Purpose of the Study:

• To evaluate a modified Keystone Design Perforator Island Flap technique for closing lower leg defects.
• To assess the flap's reliability, complication rates, and impact on patient recovery compared to traditional methods.

Main Methods:

• A modified Keystone Design Perforator Island Flap was employed, avoiding elliptical incisions and utilizing a tunneling fascia incision with a skin bridge.
• Thirty patients underwent 32 flaps, primarily for lower leg reconstruction.
• The procedure was classified as therapeutic and administered intravenously.

Main Results:

• All 32 flaps demonstrated complete survival.
• Minor complications occurred in only four patients.
• Unrestricted ambulation was possible for most patients post-surgery, with only five requiring limitations.

Conclusions:

• The modified Keystone Design Perforator Island Flap is a straightforward and reliable technique for lower leg reconstruction.
• This method offers dependable perfusion and simplifies patient recovery, often negating the need for skin grafts.