HOW WE DO IT: the Keystone flap for large skin defects: our experience with 30 consecutive cases

Area of Science:

• Plastic Surgery
• Surgical Oncology
• Dermatology

Background:

• The keystone perforator-based fasciocutaneous island flap is a reconstructive method for skin defects.
• It involves two conjoined V to Y advancement flaps.
• This study evaluates its use in skin defect reconstruction post-malignancy removal.

Purpose of the Study:

• To demonstrate the versatility of the keystone flap in various body parts.
• To evaluate clinical experience, oncological safety, and aesthetic results.
• To assess its feasibility as an alternative reconstructive method.

Main Methods:

• Retrospective review of 30 consecutive keystone flap reconstructions (Jan 2016-Jan 2021).
• Data collected included demographics, operative and oncological details, and postoperative outcomes.
• Analysis of defect location, flap type, patient risk factors, and complications.

Main Results:

• Most defects resulted from oncologic resection (97%) and were located on the pretibial region (47%).
• Minor complications occurred in 33% of cases, managed conservatively.
• No major flap-related complications or need for re-surgery were reported.

Conclusions:

• The keystone island flap is an effective and reliable technique for single-stage, tension-free closure of large skin defects.
• Its low technical complexity and high success rate make it a feasible alternative to other reconstructive options.
• The flap provides oncological safety and good aesthetic results for secondary defect closure.