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Updated: Nov 21, 2025

A Case Series of Successful Abdominal Closure Utilizing a Novel Technique Combining a Mechanical Closure System with a Biologic Xenograft that Accelerates Wound Healing

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Reconstructing Complex Open Back Wounds with a Modified Minimal-Access Keystone Flap: A Case Report.

Spencer R Anderson¹, Kyle M Rako², Sunishka M Wimalawansa¹

¹Department of Plastic Surgery, Wright State University Boonshoft School of Medicine, Dayton, Ohio.

JBJS Case Connector

|January 15, 2021

Summary

A modified Keystone flap effectively reconstructed a complex spinal wound defect in a patient, leading to successful healing. This surgical technique offers excellent tissue coverage and aesthetic results for spinal reconstruction.

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Published on: November 8, 2019

Area of Science:

Plastic Surgery
Orthopedic Surgery
Wound Reconstruction

Background:

Complex spinal wounds pose significant reconstructive challenges.
Postoperative dehiscence and infection require innovative surgical solutions.

Observation:

A 61-year-old patient presented with a complex, infected, and dehisced paraspinal wound 12 days post-operation.
Initial debridement and hardware revision were performed.
A significant skin and tissue defect remained after addressing the deep dead space with muscle flaps.

Findings:

A modified Keystone flap was utilized to reconstruct the large defect.
The flap eliminated the need for a lateral cutaneous incision.
The patient achieved complete wound healing without complications.

Implications:

The modified Keystone flap is a viable option for spinal wound reconstruction.
This technique provides excellent tissue coverage, flap advancement, and aesthetic outcomes.
Eliminating the lateral incision enhances reconstructive versatility and patient results.