Decreasing ALT donor site morbidity with the keystone flap

Area of Science:

• Plastic Surgery
• Reconstructive Surgery
• Microsurgery

Background:

• Anterolateral thigh (ALT) flaps are versatile for wound reconstruction.
• Large skin paddle defects in ALT flaps can lead to significant donor site morbidity.
• Skin grafting is often required for closure when primary closure of ALT donor sites is not possible.

Observation:

• This study reviewed six patients who underwent ALT flap reconstruction with keystone flap closure of the donor site.
• The average ALT skin paddle width was 7.8 cm, precluding primary closure.
• Keystone flap dimensions averaged 9.5 × 17.8 cm, with no major complications reported.

Findings:

• Keystone flap closure of ALT donor sites is a viable strategy for defects exceeding 8 cm in width.
• This technique successfully avoided the need for skin grafting in all reviewed cases.
• No significant donor or recipient site complications or decreased range of motion were observed.

Implications:

• The Keystone flap is a safe and effective method to manage ALT flap donor sites, minimizing morbidity.
• This approach can prevent the complications associated with secondary skin grafting.
• It expands reconstructive options for complex ALT flap donor site closures.