Customized reconstruction with rotation Hemi-Keystone flap

The keystone perforator flap has become a versatile alternative for reconstruction of cutaneous defects of various etiologies and in all age groups. However, it demands a notable incision area proportional to defect size and is more prone to excessive tension during defect closure. We present a novel modified rotation Hemi-keystone flap that reveals its excellence in flap survival.

Between March and December 2021, a retrospective chart review was conducted of 40 patients who received rotation Hemi-keystone flap for coverage of cutaneous defects by a single surgeon. The primary outcome was successful flap survival.

We performed a total of 45 modified rotation Hemi-keystone flaps for reconstruction of cutaneous wound defects. The location of the wound defects was in the head and neck (38%), extremities (35.7%), and trunk (26.2%). The most common cause of wound defect is tumor resection (45.2%). The mean wound defect dimensions were 3.5 cm × 3 cm. The mean follow-up time was 6 months. There were no significant complications, with only one patient (2.4%) having minor wound dehiscence, which was treated by local wound care.

The current series presents a simple, reliable, and versatile modification of the traditional keystone flap that minimizes morbidity at the reconstruction site along with improvement of flap mobility for successful reconstruction of cutaneous defects in a tension-free manner. The favorable outcome of this technique contributes to the inclusion of the rotation Hemi-keystone flap as an excellent surgical option in the reconstruction of various soft tissue defects.