The keystone flap: A multi-centric experience in elderly patients treatment

Area of Science:

• Plastic Surgery
• Geriatric Medicine
• Reconstructive Surgery

Background:

• Soft tissue reconstruction in elderly patients demands rapid and reliable techniques.
• The keystone island flap (KF) has emerged as a promising solution for such cases.
• This study evaluates the efficacy of KFs in an elderly demographic.

Purpose of the Study:

• To assess the authors' experience with keystone island flaps (KFs) for soft tissue defects in elderly patients.
• To analyze complication rates and recovery times associated with KF reconstruction.
• To determine the feasibility of KFs in trunk and limb reconstruction for geriatric patients.

Main Methods:

• A multi-centric study involving 72 elderly patients (mean age 76.2 years) with soft tissue defects.
• Reconstruction performed using various types of keystone island flaps (KF I, II-A, III, IV).
• Complications and post-operative recovery were recorded and analyzed, with incidence patterns assessed using the Fisher test.

Main Results:

• The study included 72 patients with defects primarily on the torso (63.9%) and lower limbs (30.6%).
• Most lesions were oncologic (79.2%), predominantly non-melanoma skin cancers.
• Post-surgical complications occurred in 20.8% of cases (9.7% major), with no significant difference across surgical sites or KF types. Mean recovery was 4.3 days.

Conclusions:

• The keystone island flap (KF) is a rapid and reliable method for soft tissue reconstruction in elderly patients.
• It offers low morbidity and short recovery times, making it suitable for trunk and limb defects.
• Surgeons should adapt reconstructive strategies for the unique needs of the geriatric population, with KF being a viable option.