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V-Y Hemi-keystone Advancement Flap: A Novel and Simplified Reconstructive Modification
Tatyana A Petukhova1, Kristina Navrazhina1, Kira Minkis1
1Department of Dermatology, Weill Cornell Medicine, New York, N.Y.
Plastic and Reconstructive Surgery. Global Open
|April 21, 2020
Summary
A simplified V-Y hemi-keystone advancement flap offers a less complex and faster method for reconstructing skin defects, especially on lower extremities, with low complication rates.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Wound Healing
Background:
- Keystone perforator flap is popular for cutaneous defect reconstruction due to vascularity and survival.
- Traditional keystone flap design is technically demanding, time-consuming, and associated with morbidity.
- A novel, simplified modification of the keystone flap is presented to expand its reconstructive utility.
Purpose of the Study:
- To evaluate the safety and efficacy of a simplified V-Y hemi-keystone advancement flap.
- To assess wound healing complications associated with this modified flap technique.
Main Methods:
- Retrospective chart review of patients undergoing V-Y hemi-keystone advancement flap reconstruction.
- Single-surgeon series evaluating outcomes, focusing on wound healing complications.
Main Results:
- Eighty-six V-Y hemi-keystone advancement flaps were performed with a low overall complication rate of 7%.
- The majority of reconstructions were on lower extremities (87.2%).
- No complete or partial flap loss was observed; surgical site infections occurred in 4 out of 5 cases on lower extremities.
Conclusions:
- The V-Y hemi-keystone advancement flap simplifies surgical complexity and reduces operative time for cutaneous defect reconstruction.
- Complication rates are comparable to or lower than traditional keystone flap series.
- This technique demonstrates favorable outcomes, supporting its integration into reconstructive surgery, particularly for challenging lower extremity wounds.
