دوره 14، شماره 2 - ( 1404 )                   جلد 14 شماره 2 صفحات 121-103 | برگشت به فهرست نسخه ها


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Singh A, Sharma A, Singh R, Singh K, Singh R, Mohan A. Critical Evaluation of Keystone Reconstruction: A Retrospective Series of 32 Cases. WJPS 2025; 14 (2) :103-121
URL: http://wjps.ir/article-1-1473-fa.html
Critical Evaluation of Keystone Reconstruction: A Retrospective Series of 32 Cases. مجله جهانی جراحی پلاستیک. 1404; 14 (2) :103-121

URL: http://wjps.ir/article-1-1473-fa.html


چکیده:   (328 مشاهده)
Background: 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.

Methods: 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.

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

Conclusion: 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.


 
     
نوع مطالعه: مقالات اصيل | موضوع مقاله: تخصصي
انتشار الکترونیک: 1404/6/3

فهرست منابع
1. Behan FC. The Keystone design perforator island flap in reconstructive surgery. ANZ J Surg 2003; 73(3):112-120. [DOI:10.1046/j.1445-2197.2003.02638.x]
2. doi:10.1046/j.1445-2197.2003.02638.x. PMID:12608972 [DOI:10.1046/j.1445-2197.2003.02638.x]
3. Behan FC, Sizeland A. Keystone perforator island flaps in major head and neck surgery - The P.A.C.E. perspectives. World J Surg Surg Res 2021;4:1293.
4. Huang J, Kim CW, Wang X, Zhao Y, Yu N, Zhao R, et al. Successful application of modified Keystone flaps following skin tumor ablation. Medicine (Baltimore) 2019; 98(40):e17469. doi: 10.1097/MD.0000000000017469. [DOI:10.1097/MD.0000000000017469]
5. Kong YT, Kim J, Shin HW, Kim KN. Keystone flap with Omega variation and Sydney Melanoma Unit Modification to cover small- and moderate-sized defects in the anterior lower leg. J Wound Manag Res 2021;17(2):94-101. [DOI:10.22467/jwmr.2020.01452]
6. doi:10.22467/jwmr.2020.01452. [DOI:10.22467/jwmr.2020.01452]
7. Behan FC, Rozen WM, Lo CH, Ashton MW, Hunter-Smith DJ, Findlay MW, et al. The omega-variant designs (Type A and B) of the Keystone perforator island flap. ANZ J Surg 2011;81(9):650-652. doi: 10.1111/j.1445-2197.2011.05833.x. PMID: 22295410. [DOI:10.1111/j.1445-2197.2011.05833.x]
8. Gomez OJ, Baron OI, Penarredonda ML. Keystone flap: overcoming paradigms. Plast Reconstr Surg Glob Open 2019;7(3):e2126. doi: 10.1097/GOX.0000000000002126.PMID:31044108;PMCID:PMC6467614. [DOI:10.1097/GOX.0000000000002126]
9. Sinna R, Boloorchi A, Mahajan AL, Qassemyar Q, Perrow R, Dardour JC, et al. What should define a "perforator flap"? Plast Reconstr Surg 2010; 126(6):2258-2263. doi: 10.1097/PRS.0b013e3181f61824. PMID: 21124168. [DOI:10.1097/PRS.0b013e3181f61824]
10. Rini IS, Gunardi AJ, Marsaulina RP, Aryandono T, Dachlan I, Dwiraphasto I. A systematic review of the Keystone design perforator island flap in the reconstruction of trunk defects. Arch Plast Surg 2020; 47(6):535-541. [DOI:10.5999/aps.2020.00094]
11. doi:10.5999/aps.2020.00094. Epub 2020 Nov 15. PMID: 33238340; PMCID: PMC7700866.
12. Mohan AT, Sur YJ, Zhu L, Morsy M, Wu PS, Moran SL, et al. The concepts of propeller, perforator, Keystone, and other local flaps and their role in the evolution of reconstruction. Plast Reconstr Surg 2016; 138(4):710e-729e. [DOI:10.1097/PRS.0000000000002610]
13. doi:10.1097/PRS.0000000000002610. PMID: 27673542. [DOI:10.1097/PRS.0000000000002610]
14. Taylor GI, Palmer JH. The vascular territories (angiosomes) of the body: experimental study and clinical applications. Br J Plast Surg 1987; 40(2):113-141. doi: 10.1016/0007-1226(87)90185-8. PMID: 3567445. [DOI:10.1016/0007-1226(87)90185-8]

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