The Keystone Perforator Island Flap and its Use in Complex Defects of the Trunk: a Case Report

Complex defects of the trunk present a reconstructive challenge and conservative treatment is frequently unsuccessful. Perforator flaps have become a common option for this problem. The keystone perforator island flap (KPIF) is a fasciocutaneous advancement flap, based on randomly located perforators vessels, whose dissection and exposure is not required. Designed in a curvilinear trapezoidal shape, it allows primary closure of large defects, while avoiding secondary defects and minimizing the need for more complex pedicled flaps or microsurgical reconstructive techniques. The clinical case of a 52-year-old male with stable coronary artery disease and severe aortic stenosis, with severe left ventricular dysfunction, who underwent coronary artery bypass graft surgery and aortic valve replacement is presented. During the post-operative period, he developed anterior mediastinitis and presented a large median sternotomy wound dehiscence, refractory to medical treatment and surgical debridement. The patient underwent reconstruction of the defect with a bilateral KPIF and application of VAC therapy, with favorable outcome. The KPIF is an useful and reliable reconstruction technique for complex defects, that has shown shorter operative times, lower risk of total flap necrosis, reduced donor-site morbidity and favorable aesthetic results, making it a good option in patients with multiple comorbidities.