The keystone flap, a versatile reconstructive solution: surgical options and a long-term experience

What is it about?

Background The keystone island flap allows quick reconstruction of skin losses in different areas, as an alternative to skin grafts or free flaps. Hypotesis The described keystone island flap is shaped as two V-to-Y advancing flaps that are supplied by musculocutaneous and fascio-cutaneous perforator vessels. Methods For the patients enrolled in the present study, keystone island flap was chosen as a surgical strategy after oncologic resections for the reconstruction of defects of the trunk or extremities derived from of tumors. The study involved 20 patients, from 2015 to 2021. After tumor removal, all patients underwent an immediate reconstruction; margins were cleared on the first resection in all cases. Results There were no flap losses. The complication rate was 10.9%, and there were no major complications. Minor complications included two cases of dehiscence and one of the two cases needed another refinement surgery. Conclusions This study shows that the keystone island flap can be a useful reconstruction option even in large defects of the trunk and extremities. Implications for clinical practice The described keystone island flap can be used to easily cover wounds of the trunk or extremities.

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