Random Perforator Flap : Some Experiences with Keystone Flap

Sudjatmiko, Gentur; Pribadi, Sweety; Supit, Laureen

doi:10.14228/jpr.v2i2.158

Cited by 3 publications

(1 citation statement)

References 2 publications

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“…Because it is a multiperforator flap, no specific vascular pedicle needs to be determined. In the insetting phase, the flap is moved by advancement or transposition to close defect, sutured from center to edge by ensuring free tension, and a drainage tube is inserted in the inferior part of defect 10 (Fig. 1 ).…”

Section: Methodsmentioning

confidence: 99%

Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap

Rini

Gunardi

Yashinta

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Background: Late stage breast cancer presents with malignant wound causing skin infiltration, pain, bleeding, and malodour, which affect quality of life (QoL). Palliative mastectomy aims to eliminate wound symptoms and requires prolonged wound care to improve QoL. This study aimed to prospectively investigate QoL differences in 2 alternative reconstructive methods: keystone flap and rotational flap. Methods: Twenty-four late stage breast cancer patients with symptoms of cancer wounds were included in this study. They were divided into 2 groups: keystone flap and rotational flap. Each patient’s QoL was evaluated using EORTC QLQ-C30 and QLQ-BR23 before and 3 weeks after surgery. Results: Global health post-surgery was significantly improved compared with pre-surgery in all patients (P < 0.001), across both the keystone (P = 0.018) and rotational groups (P = 0.007). Breast symptoms post-surgery were also improved compared with pre-surgery in all patients (P = 0.035). However, when analyzed per group, breast symptoms were only improved significantly in the keystone group (P = 0.013) but not in the rotational group (P = 0.575). When compared between 2 groups, future perspective post-surgery in the keystone group [100 (0–100)] was better than the rotational group [66.7 (0–100)], (P = 0.020). Conclusions: Reconstructive surgery after mastectomy improves QoL in late stage breast cancer patients. The keystone flap is superior to the rotational flap in improving global health and breast symptoms.

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Section: Methodsmentioning

confidence: 99%

Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap

Rini

Gunardi

Yashinta

et al. 2021

Plastic and Reconstructive Surgery - Global Open

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Large Abdominal Defect Closure: Case Series

Handini¹,

Tiza²,

Sudjatmiko³

2024

J Plast Rekons

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Background: We will report some experiences in managing challenging malignant cases on the abdominal wall, including a case of large, irradiated defect. All of those cases were consulted intraoperative immediately following tumor removal. The keystone random perforator flap was chosen among the option of solutions in large abdominal defect closure. This region has natural elasticity, which combines well with the multi-axial tissue recruitment of the flap Methods: Three cases of complicated abdominal defect were reconstructed using the keystone flaps supplied by non-identified (random) perforators. Results: All flaps survived without problem of vascularization, despite of its large defect, sequence of radiotherapy following reconstruction, infection, and with its margin unable to be freed from tumor. One out of three cases suffered from contaminated wound from stomal leakage, leading to dehiscence. Conclusion: The keystone flap is a useful and reliable random perforator-based flap, even in complex and challenging malignant cases of abdominal wall.

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Simple Metric Measurement To Choose A keystone Flap Design On Extremities: A Cadaveric Study

Hariwangsa¹,

Sudjatmiko²

2024

J Plast Rekons

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Background: Closing defect on extremities can be challenging because of limited donor area in order to obtain similar quality, color, texture, and adequate size with the defect. The keystone flap has gained popularity as a tool for local reconstruction because of its simple design, short operative time, good aesthetic outcome, and cost-effective wound closure. The aim of this study is to introduce a method in choosing a keystone flap design based on simple metric measurement resulting in lower tension.. Methods: Four circular defects were created on 4 different regions of a fresh cadaver’s upper limbs. Diameters were 5 cm for upper arms and 3 cm for lower arms. Two options of keystone flaps designs were introduced. The keystone could be advanced in longitudinal manner or in transversal manner according to limb’s axis. We then calculated the percentage of the skin required to stretch, in order to close the defects. The less percentage of skin required to stretch between the two manners indicated the lower tension of the keystone flap. Results: Measurements in all of 4 regions of upper limbs showed that the percentage of skin stretch in closing the defects was lower in longitudinal advancement keystone flap compared to transversal advancement (19.88% versus 27.8% for upper arms and 15.71% versus 21.67% for lower arms) Conclusion: Simple metric measurements in choosing a keystone flap can be applied to defects on extremities. With less tension when raising the keystone flap, acceptable scar is expected and the occurrence of contracture and flap necrosis can be reduced.

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Random Perforator Flap : Some Experiences with Keystone Flap

Cited by 3 publications

References 2 publications

Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap

Quality of Life in Palliative Post-mastectomy Reconstruction: Keystone versus Rotational Flap

Large Abdominal Defect Closure: Case Series

Simple Metric Measurement To Choose A keystone Flap Design On Extremities: A Cadaveric Study

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