Critical Evaluation of Keystone Reconstruction: A Retrospective Series of 32 Cases

We aimed to create focus and awareness about versality of keystone flap in safe re-surfacing of small to medium and large sized skin defects in single stage with minimal donor site morbidities and maximum anatomical, functional and aesthetic results.

Retrospective study was conducted between October 2021- December 2022 on 26 males and 5 females aged 20-70 years who underwent 32 Keystone flap reconstruction (type IIA n=11, type IIB n=7 type III n=6, Type IV n=8) in diversity of defects following: domestic electric burn on pulp of thumb (n=2), chronic discharging sinus over clavicle (n=1), post-traumatic wounds on eighteen legs (n=19), excision of unstable scar over shin of tibia (n=4), exit wound on medial aspect of foot (n=3) and excision of non-healing ulcer over heel (n=3). Flaps were designed in a way to keep maximum perforators in pedicular area and to ascertain maximum mobility. After debridement, wound area ranged from 4mm x 4mm to 17 x 8 cm. The flap size ranged from 5mm x 5mm to 18cm x 8cm. Follow- ups ranged from 1 month to 12 months.

Three cases developed partial wound dehiscence which were managed subsequently. None of the flap had partial or total loss. Over-all results were satisfying.

Our series highlighted that keystone flaps have defect adaptive design and are technically easy to perform, cost and time effective and can be designed from head to toe (omnipresence) with excellent outcome. We advocate their use as robust reconstructive tool for Plastic surgeons, Orthopedic surgeons and Dermatosurgeon.