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The Keystone Flap for Vulvar Reconstruction: A Case Series and BODY-Q Evaluation
Filippo Boriani1, Ettore Gasparo1, Matteo Atzeni1
1From the Plastic Surgery and Microsurgery Unit, Department of Surgical Sciences, Faculty of Medicine and Surgery, University Hospital "Duilio Casula," University of Cagliari, Cagliari, Italy.
Plastic and Reconstructive Surgery. Global Open
|May 22, 2026
Summary
The keystone perforator island flap (KPIF) offers a safe and effective method for vulvar reconstruction after cancer surgery. This technique provides excellent aesthetic and functional outcomes, leading to high patient satisfaction.
Area of Science:
- Oncology
- Plastic Surgery
- Gynecologic Oncology
Background:
- Vulvar carcinoma is a rare cancer primarily affecting women over 60, with squamous cell carcinoma being the most common type.
- Vulvectomy followed by reconstruction is the standard treatment for vulvar cancer.
- The keystone perforator island flap (KPIF) is a novel reconstructive technique known for its vascularity, low complication rates, and quick recovery.
Purpose of the Study:
- To evaluate the safety, efficacy, and patient-reported outcomes of the keystone perforator island flap (KPIF) for vulvar reconstruction post-vulvectomy.
- To assess aesthetic and functional results using the BODY-Q questionnaire, a novel approach for this specific reconstruction.
Main Methods:
- Retrospective analysis of 14 patients who underwent KPIF reconstruction after vulvectomy between 2016 and 2024.
- Data collection included demographics, clinical details, operative parameters, and postoperative outcomes.
- Patient satisfaction was assessed using the BODY-Q questionnaire.
Main Results:
- The study included 14 patients with a mean age of 74; 86% had squamous cell carcinoma.
- Average operative time was 278 minutes, with a mean hospital stay of 11.5 days.
- Limited complications were observed, with satisfactory oncological, aesthetic, and functional results, and very high patient satisfaction via BODY-Q.
Conclusions:
- Keystone perforator island flap (KPIF) is a safe, simple, and reproducible technique for vulvar reconstruction.
- KPIF offers favorable aesthetic and functional results with advantages like concealed donor sites and fewer complications compared to other flaps.
- This technique is a valuable addition to the surgical options for vulvar reconstruction.