The Keystone Flap-A Case Series Demonstrating Practical Design, Use, and Applications.

Area of Science:

• Plastic Surgery
• Reconstructive Surgery

Background:

• The keystone design perforator island flap is a trapezoidal random perforator island flap.
• It presents advantages over primary closure, skin grafting, and other local flaps for soft tissue reconstruction.
• It is commonly used following cancer excisions.

Purpose of the Study:

• To review the practical design, use, and applications of the keystone flap.
• To highlight important considerations for its application.
• To evaluate its efficacy in soft tissue reconstruction.

Main Methods:

• A case series of 39 keystone flaps in 37 patients was reviewed.
• Flaps were designed as per the original description with a modification for the lower extremity.
• A higher flap to defect width ratio was used in the lower extremity.

Main Results:

• 39 defects ranging from 6 to 63 cm² were reconstructed in 37 patients (23 males, 14 females).
• Patients ranged in age from 49 to 89 years.
• Two minor complications (partial flap dehiscence) occurred; no major complications like flap loss were observed.

Conclusions:

• The keystone flap is a versatile and reliable option for reconstruction across most body areas.
• A flap width to defect width ratio of up to 1:3 is recommended for the lower extremity due to higher tension.