Repair of a Large Sternal Notch Defect

Commentary on Reconstruction of a Large Thoracolumbar Defect

“…5 The keystone flap is ideal for the lower leg but has been used on the trunk for large defects, especially with a bilateral or modified keystone approach. 6,7…”

“…5 The keystone flap is ideal for the lower leg but has been used on the trunk for large defects, especially with a bilateral or modified keystone approach. 6,7 Importantly, the authors point out the use of tumescent anesthesia to help control lidocaine toxicity and bleeding in large reconstructions, something commonly used in deep melanoma resections and liposuction. It is important to monitor the amount of lidocaine used throughout the case (which may have worn off by the time a large piece of tissue processes) and keep the patient comfortable while numbing.…”