A comparative study for tension-reducing effect of Type I and Type II keystone perforator island flap in the human back

Abstract

The keystone perforator island flap (KPIF) is popular in reconstructive surgery. However, despite its versatility, its biomechanical effectiveness is unclear. We present our experience of KPIF reconstruction in the human back and evaluate the tension-reducing effect of the KPIF. Between September 2019 and August 2020, 17 patients (51.82 ± 14.72 years) underwent KPIF reconstruction for back defects. In all cases, we measured wound tension at the defect and donor sites before and after KPIF reconstruction using a tensiometer. All defects occurred after complete excision of complicated epidermoid cysts and debridement of surrounding tissues. The defects were successfully covered with Type IIA KPIFs. All flaps survived, and there were no significant postoperative complications. The mean “tension change at the defect after Type I KPIF” and “tension change at the defect after Type II KPIF” were − 2.97 ± 0.22 N and − 5.59 ± 0.41 N, respectively, (P < 0.001). The mean “rate of tension change at the defect after Type I KPIF” and “rate of tension change at the defect after Type II KPIF” were − 36.54 ± 1.89% and − 67.98 ± 1.63%, respectively, (P < 0.001). Our findings confirm the stepwise tension-reducing effect of KPIF and clarify the biomechanics of this flap.

Vessel Loop Shoelace Technique followed by Keystone Flap to Treat a Large Mid-back Defect

“…Therefore, one of the key points in repairing back wounds is to minimize tension for successful healing. The keystone flap is known to be versatile because of its simplicity, good vascularity, tension-reducing effect, 8 potential for “like-with-like” replacement, and no need for microsurgery. Other alternative local flaps such as the trapezius flap or latissimus dorsi flap 2 were withdrawn in this case due to surgical complexity and prolonged operation time.…”

Modified Keystone Perforator Island Flap for Tension‐Reducing Coverage of Axillary Defects Secondary to Radical Excision of Chronic Inflammatory Skin Lesions: A Retrospective Case Series

“…Our empirical antibiotic regimen included intravenous injection of either cefazedone sodium 1 g or amoxicillin sodium 1.2 g. Our wound dressing protocol included conventional dressing with foam and packing materials to control acute inflammation, followed by negative pressure wound therapy to promote tissue perfusion and stabilization. After achieving adequate wound preparation and stabilization through these management procedures, we performed radical excision followed by KPIF reconstruction [ 4 , 5 , 13 , 15 ].…”

“…Then, the final defect was created. The KPIF was designed based on the final defect size, surrounding tissue laxity, and relaxed skin tension lines (RSTLs) of the axilla [ 4 , 5 , 7 , 13 ]. We designed the KPIF to have a larger width than the defect at the side with sufficient tissue laxity and attempted to create the KPIF long axis, so that it was as parallel to the RSTLs as possible [ 4 , 5 , 7 , 13 ].…”

“…Among the numerous types of local flaps, the keystone perforator island flap (KPIF) technique devised by Behan in 2003 has demonstrated successful outcomes in a series of 300 cases. This reconstructive modality can be applied to cover various defects in most parts of the human body and is used by many reconstructive surgeons as a primary option or an alternative to other reconstructive methods [ 4 , 5 , 7 , 12 , 13 ]. The popularity of the KPIF technique is thought to be attributable to its distinct differences from other flaps, including its intuitive defect-adjustable design and easy reproducibility; even beginners can perform this technique with a minimal learning curve [ 4 , 5 , 7 , 13 ].…”

“…This reconstructive modality can be applied to cover various defects in most parts of the human body and is used by many reconstructive surgeons as a primary option or an alternative to other reconstructive methods [ 4 , 5 , 7 , 12 , 13 ]. The popularity of the KPIF technique is thought to be attributable to its distinct differences from other flaps, including its intuitive defect-adjustable design and easy reproducibility; even beginners can perform this technique with a minimal learning curve [ 4 , 5 , 7 , 13 ]. Several studies have reported the use of the KPIF for reconstructing axillary defects [ 2 , 14 ]; however, relatively more studies have compared KPIF reconstruction in other body areas.…”