Keystone flap: a safe coverage option in the handling of salvage for myelomeningocele

Gómez, O.; Barrera, Carlos Roberto Peña

doi:10.1007/s00381-020-04662-y

Cited by 5 publications

(7 citation statements)

References 24 publications

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“…Eight previous studies have discussed the use of KDPIFs for meningomyelocele defect closure [15,[18][19][20][21][22][23][24]. All of those studies also demonstrated satisfactory experiences in using KDPIFs for meningomyelocele closure.…”

Section: Discussionmentioning

confidence: 93%

“…All of those studies also demonstrated satisfactory experiences in using KDPIFs for meningomyelocele closure. The studies by Gutman et al [15], Park et al [19], Jamjoom et al [20], Mrad et al [21], and Gomez and Barrera [22] reported no complications after defect closure using keystone flaps in between one and five patients. Donaldson et al [18] reported that two out of six patients had wound complications after surgery.…”

Section: Discussionmentioning

confidence: 96%

“…All previous studies mainly used type III keystone flaps. Hifny and Hamdan [24] used type II keystone flaps in two patients and Gomez and Barrera [22] used type IV keystone flaps in two patients. In our study, we presented various types of keystone flaps to close defects with different sizes, and we proposed an algorithm for the reconstruction of meningomyelocele defects using keystone flaps based on the size of the defects and the proportion of the width of the defect to the width of the patient's back (Fig.…”

Section: Discussionmentioning

confidence: 99%

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Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

2021

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Background Various methods have been described to close large meningomyelocele defects, but no technique has been proven superior to others. This study presents cases of meningomyelocele defect closure with a keystone-design perforator island flap.Methods A retrospective study was performed on 14 patients with meningomyelocele defects closed using various types of keystone flaps.Results The median age of the patients at surgery was 10.5 days (range, 1–369 days) and the average defect size was 22.5 cm2 (range, 7.1–55.0 cm2). The average operative time for defect closure was 89.6 minutes (range, 45–120 minutes). Type IV bilateral keystone flaps were used for four defects, type IV unilateral flaps for six defects, type IIA flaps for two defects, and type III flaps for two defects.Conclusions All the defects healed completely with no major complications. The keystone-design perforator island flap is a reliable, easy, and fast technique to close large meningomyelocele defects.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

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Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

2021

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“…Minor complications (seromas or peripheral and partial dehiscence) occur in about 20% of cases. Primary closure and transposition flaps are the procedures with the highest rates of complications 5 , which is why this flap has begun to be implemented with promising results, such as a success rate of up to 97% and a reduction in the need for multiple surgical interventions newborn 12 .…”

Section: Discussionmentioning

confidence: 99%

Keystone flap as a reconstructive option in complex posterior midline defects

Pineda-Espinosa¹,

Maza²,

Fernandez-Rojas³

et al. 2022

HGMX

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Local flaps or based on a single perforator have great utility in reconstructive surgery, however, its use is complicated posterior midline due to the characteristics of the tissues, the keystone flap described in 2003 has become one of the main options for reconstruction due to safety, easy reproducibility, shorter surgical time, and shorter learning curve, there are three cases of posterior midline defects where the characteristics of the patient required a shorter recovery time with adequate functional and esthetic results.

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“…The implicit preservation of perforators in the center of the flap design allows for a safer procedure when compared to random flaps that can undergo dehiscence or partial necrosis, transposition flaps that are usually limited to small defects [15], or flaps that, when large, require skin grafting for the donor site [8]. Although some authors have considered the keystone flap a salvage procedure following a failed primary closure, we use bilateral keystone flaps despite the size of the defect for the reconstruction of large defects in our practice [16]. The surface area of defects in our patients was greater than in most studies.…”

Section: Discussionmentioning

confidence: 99%

Myelomeningocele defect reconstruction with keystone flaps: vascular rationale for the design and operative technique

Kushida-Contreras

Gaxiola-García

2021

Arch Plast Surg

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Background Myelomeningocele is a frequently seen condition at tertiary care hospitals. Its treatment involves a variety of plastic reconstructive techniques. Herein, we present a series of myelomeningocele patients treated using keystone flaps.Methods We gathered information regarding soft tissue reconstruction and the use of bilateral keystone flaps to treat myelomeningocele patients. We obtained data from clinical records and recorded the demographic characteristics of mothers and children with the condition. The size, level of defect, and complications detected during the follow-up were analyzed.Results A series of seven patients who underwent bilateral keystone flaps for myelomeningocele closure was analyzed. There were no cases of midline or major dehiscence, flap loss, necrosis, surgical site infections, or cerebrospinal fluid leakage. No revision procedures were performed. Minor complications included one case with minimal seroma and three cases with areas of peripheral dehiscence that healed easily using conventional measures.Conclusions The use of keystone flaps is an adequate option for closure of dorsal midline soft tissue defects related to myelomeningocele. This technique offers predictable results with an acceptable spectrum of complications. Robust blood flow can be predicted based upon anatomical knowledge.

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Keystone flap: a safe coverage option in the handling of salvage for myelomeningocele

Cited by 5 publications

References 24 publications

Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

Closure of meningomyelocele defects using various types of keystone-design perforator island flaps

Keystone flap as a reconstructive option in complex posterior midline defects

Myelomeningocele defect reconstruction with keystone flaps: vascular rationale for the design and operative technique

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