Customized reconstruction with rotation Hemi‐Keystone flap

Abstract

Introduction The keystone perforator flap has become a versatile alternative for reconstruction of cutaneous defects of various etiologies and in all age groups. However, it demands a notable incision area proportional to defect size and is more prone to excessive tension during defect closure. We present a novel modified rotation Hemi‐keystone flap that reveals its excellence in flap survival. Methods Between March and December 2021, a retrospective chart review was conducted of 40 patients who received rotation Hemi‐keystone flap for coverage of cutaneous defects by a single surgeon. The primary outcome was successful flap survival. Results We performed a total of 45 modified rotation Hemi‐keystone flaps for reconstruction of cutaneous wound defects. The location of the wound defects was in the head and neck (38%), extremities (35.7%), and trunk (26.2%). The most common cause of wound defect is tumor resection (45.2%). The mean wound defect dimensions were 3.5 cm × 3 cm. The mean follow‐up time was 6 months. There were no significant complications, with only one patient (2.4%) having minor wound dehiscence, which was treated by local wound care. Conclusions The current series presents a simple, reliable, and versatile modification of the traditional keystone flap that minimizes morbidity at the reconstruction site along with improvement of flap mobility for successful reconstruction of cutaneous defects in a tension‐free manner. The favorable outcome of this technique contributes to the inclusion of the rotation Hemi‐keystone flap as an excellent surgical option in the reconstruction of various soft tissue defects.

The Versatility of Keystone Flaps for Skin Cancer Reconstruction of the Nose

“…The dimension of the nasal defects ranged from 0.5×1 to 2.5×2.5 cm 2 with a mean size of 1.1×1.2 cm 2 using either a conventional keystone flap or its modification, including the Omega variant and rotation Hemi-keystone flap. The defects were reconstructed with traditional flap 10 in 6 cases (50%), Omega variant keystone flap 7 in 4 cases (33%), and rotation Hemi-keystone flap 11 in 2 patients (17%).…”

“…Furthermore, we performed a rotation Hemi-keystone flap to repair a nasal tip defect in case #3. 11,12 . This modification involves incising the V portion of the keystone flap design at one side and extending it to one-half of the greater curvature.…”

“…Furthermore, we performed a rotation Hemi-keystone flap to repair a nasal tip defect in case #3 11,12 …”

“…Following tumor resection with a safety margin, a rotation Hemi-keystone keystone flap was designed on one side of the defect as previously described. 11,12 An incision is made along the marked flap, and the curvilinear portion of the flap is then undermined, rotated, and closed the defect tension-free. The representative case is shown in Figure 4.…”

Myelomeningocele Defects Reconstruction With Various Types of Keystone Flaps: An Algorithmic Approach Based on Defect Shape

“…The keystone perforator island flap becomes an accepted and effective tool in the plastic surgeon’s armamentarium, providing durable soft tissue coverage with minimal morbidity 7–9 . Several studies have described its use to repair significant myelomeningocele defects 10–13 .…”