Giant keystone type III perforator flaps for dermatofibrosarcoma protuberans defect reconstruction
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Published on: December 5, 2025
Maria Eliza Nedu1, Ileana Rodica Matei1, Alexandru Valentin Georgescu1
1Department of Plastic Surgery, University of Medicine and Pharmacy "IuliuHatieganu", Cluj-Napoca, Romania; Department of Plastic Surgery Spitalul Clinic de Recuperare, Rehabilitation Clinical Hospital Cluj-Napoca, Str. Viilor 46-50, Cluj Napoca 400347, Romania.
Introduction:
Dermatofibrosarcoma protuberans (DFSP) is a relatively rare malignant tumor, with important local aggressiveness.
Case Report:
We present a case of a 59-years-old man with a history of Psoriasis and viral hepatitis C presented in our department with a giant lesion on the posterior trunk, of 24/36 cm, with pus and local bleeding, causing important anemia. The tumor was excised, creating an elliptical defect of around 34 × 42 cm down to fascial level, which was covered by two lateral flaps - modified Keystone type III.
Results:
The flaps were completely viable and integrated with small dehiscence, which were assisted to heal secondarily.
Conclusion:
Our paper presents a reliable alternative to skin grafting for a very large defect on the posterior trunk, the modified type III keystone flap, to our knowledge, for the first time presented for such a wide defect and on adult.
