Utility of Keystone Flap in Armory of Dermatosurgeons

Abstract

Purpose and Background To create awareness among dermatosurgeons about the versatility of keystone flaps in re-surfacing post-excisional small, medium and large skin defects. Aims and Objectives Single-staged tension-free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome. Material and Methods This retrospective study was conducted, between October 2021 – January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years. Sixteen Keystone flaps (type IIA n=13, Omega cum Sydney melanoma unit modification n=3) were utilized for resurfacing skin defects arising after excision of basal cell carcinoma (n=3) and benign hairy nevus (n=2) on cheek, basal cell carcinoma forehead (n=1), electric burns on deltoid (n=2), giant neurofibroma back (n=1), tattoo forearm (n=3), chronic non-specific granuloma thumb (n=2) and pilonidal sinus disease (n=2). Skin with maximum expansibility was chosen as donor site with utmost care of facial lines and its aesthetic subunits. Flaps were dissected all around preserving maximum number of hand-held Doppler-identified perforators in pedicular area. Sutures were removed on 10th to 15th post-operative day. Follow-ups ranged from 2 to 15 months. Results None had wound dehiscence or loss of flap. Conclusion Keystone flaps have defect-adaptive design, simple bio-geometry, technical simplicity, decreased downtime, cost effectivity and efficiency and can be designed to resurface post-excisional skin defect from head to toe with acceptable results, therefore should strongly be considered by dermatosurgeons while excising skin lesions.

Keywords

• keystone flap
• perforators
• pedicular area