The application of keystone flap combined with vacuum‐assisted closure in the repair of sacrococcygeal skin defect after tumor resection

Wu, Mengyin; Sun, Mengyan; Dai, Haiying; Xu, Jianguo; Wang, Xinwei; Guo, Rui; Wang, Yuchong; Xue, Chunyu

doi:10.1002/jso.25397

Cited by 5 publications

(7 citation statements)

References 21 publications

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“…The resection of sacrococcygeal tumors often results in complex defects 14 ; the reconstruction of these defects is often challenging, especially when the skin defect and dead space are at different sites and when the defects are associated with exposed prosthesis and infection 15 . A previous systematic review and meta-analysis identified gluteal-based and vertical rectus abdominis musculocutaneous flaps as the 2 most common options for soft tissue reconstruction after sacrectomy 16 .…”

Section: Discussionmentioning

confidence: 99%

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap

Yu,

Jin,

Zang

et al. 2023

Ann Plast Surg

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Background Complex soft tissue defects, which result from the surgical resection of sacral tumors, manifest as a combination of skin defects, dead space, infection, and prosthesis exposure. Because the traditional musculocutaneous flap lacks flexibility because of the close connection between the skin flap and the muscle component, the musculocutaneous flap is not suitable for reconstructing complex soft tissue defects where the dead space and skin defects are located at different sites. Furthermore, the perforator flap is also not appropriate for reconstructing complex defects because it lacks the muscular component. We considered the possibility of using the chimeric perforator propeller flap for reconstructing complex sacrococcygeal defects. Methods This study included 7 patients who underwent, between July 2007 and July 2021, the reconstruction of complex soft tissue defects of the sacrococcygeal region using a chimeric perforator propeller flap. Results Among the included cases, the etiologies were chordoma (n = 3), sacral tumor (n = 3), and squamous cell carcinoma (n = 1). In all the cases, vacuum-assisted closure therapy was used to treat wound infections before surgery. The average sizes of the skin and muscle flaps were 195.8 cm2 (range, 100–350 cm2) and 83.6 cm2 (range, 60–140 cm2), respectively. The superior gluteal artery was the source artery for the chimeric perforator propeller flap. The donor sites were primarily closed in all cases. One patient had delayed wound healing, and the secondary wound healed using conservative dressing changes. The other 6 flaps had no complications. The average follow-up time was 5.3 months (range, 1–9 months). Muscle weakness and compromised ambulation in the affected lower extremities were not observed in any of the patients. Furthermore, all 7 patients had no tumor recurrence, prosthesis exposure, and infection events in the sacrococcygeal region. Conclusions The chimeric perforator propeller flap may be an option for reconstructing complex soft tissue defects in the sacrococcygeal region.

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Section: Discussionmentioning

confidence: 99%

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap

Yu,

Jin,

Zang

et al. 2023

Ann Plast Surg

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“…Furthermore, the modified Limberg flap with the pedicle at the upper pole provides thicker tissue because the blood supply to the sacrococcygeal region is more abundant here than at the lower pole. 20 Similarly, placing the flap pedicle on the upper pole minimizes the effect of flap transposition on the ipsilateral hip shape, resulting in better surgical aesthetic results. It should be noted that the side length of the flap was calculated based on the distance between the intersection point and the lower pole.…”

Section: Discussionmentioning

confidence: 99%

Simplified and modified Limberg flap plus vacuum‐assisted closure for treatment of sacrococcygeal pilonidal sinus disease

Xu,

Wang,

et al. 2023

International Wound Journal

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BackgroundPilonidal sinus disease (PSD), a chronic inflammatory disease, affects the sacrococcygeal soft tissue, especially in young adults. The ideal treatment for PSD remains divergence. This study evaluated the application of a simplified modified Limberg flap combined with vacuum‐assisted closure for treating PSD.MethodsThis prospective study was conducted from 1 June 2017 to 31 March 2022 in Changhai Hospital, Naval Military Medical University, Shanghai, China. The study included 88 male patients (91.7%) and 8 female patients (8.3%). The 96 patients ranged in age from 15 to 34 years (mean ± SD, 23 ± 4.4). Under general anaesthesia, all patients underwent simplified modified Limberg flap reconstruction with vacuum‐assisted closure. The patient's weight, surgical time, extubation time, hospital stay, time to return to normal life or work, wound infection, wound dehiscence and recurrence rate were recorded. The visual analogue scale (VAS) score and the Vancouver scar score were used to score patients' pain and scars in the surgical area.ResultsThe volume of resected diseased tissue was 13.5–120 (mean ± SD, 34.993 ± 24.406) cm2. The average surgical time during the treatment period was 97.68 ± 18.72 min, and the average extubation time was (6.36 ± 1.55) days, the mean hospital stay was 19.4 days; no patients were lost to follow‐up. None of the patients experienced post‐operative recurrence, wound infection, seroma or hematoma. Six patients (6.3%) experienced wound dehiscence at the flap tip around the natal cleft. The mean time to the resumption of daily activities was 26.3 days. The average VAS pain score was (6.00 ± 1.53) points, and the average Vancouver scar score was (5.96 ± 1.51) points, 12 patients (12.5%) were dissatisfied with their aesthetic results, and the average beauty satisfaction score is (6.64 ± 1.28) points.ConclusionsSimplified modified Limberg flap reconstruction with vacuum‐assisted closure surgery is an effective and innovative method for the treatment of PSD, with a low recurrence rate and rapid recovery.

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“…The keystone flap has been reported to be a versatile flap for reconstruction of the head and neck, 11 trunk, 12 limb, 13 and perineal regions. 12 It can be used as a primary or secondary reconstructive option, and it can be performed simultaneously with another flap.…”

Section: Discussionmentioning

confidence: 99%

“…To achieve a successful reconstruction, a proper debridement of devitalized tissue and, in some occasions, an application of a vacuumassisted closure device, may be required. 13 The intrinsic elasticity of the keystone flap allows for a reduction and a redistribution of the tension compared to the pre-flap wound. 5,14 The wound is designed in an elliptical shape, with one after tumor resection, epidermoid cyst removal, or treatment of myelomeningoceles.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of the keystone perforator island flap for oncologic reconstruction of the back

Yan

Rose

Houdek

et al. 2021

Journal of Surgical Oncology

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Background: Coverage of posterior trunk defects after tumor resection can be challenging due to the intricate anatomy. The keystone perforator island flap (KPIF) provides coverage of the defect without the need for distant flap coverage or microsurgery, matches the recipient's skin color and contour, and requires a short operative time.Methods: A retrospective review of all oncological back reconstructions with KPIF was performed at our institution. The patient comorbidities and surgical outcomes were collected.Results: A total of 17 patients underwent 20 KPIF (15 single and 2 double) for back reconstruction. Surgical indications were sarcoma (n = 12) and melanoma (n = 5). The mean age at surgery was 47.3 years (SD 23.3). The flaps were located in the upper back (n = 8), paraspinal (n = 4), middle back (n = 6), and lower back (n = 2). The average wound size after sarcoma and melanoma excision were 231.6 ± 297.4 and 156.7 ± 269.7 cm 2 , respectively. Four patients required an additional planned skin graft and one patient underwent a simultaneous myocutaneous latissimus dorsi flap.The mean operative time, including tumor resection, was 256 min (SD 118). The median length-of-hospital stay was 3 days (Q1-3: 1-6.5) and the median follow-up time was 35.3 months (Q1-3: 13.3-53.1). All flaps survived with minor surgical complications which included hematoma (n = 1), surgical site infection requiring debridement (n = 1), superficial wound dehiscence (n = 1), cellulitis (n = 1), and seroma (n = 1). The reconstructions were successful in 100% of patients. Conclusions:The KPIF is a reliable and safe option for reconstruction of oncological back defects with minimal perioperative complications. This flap option avoids the use of free flaps and myocutaneous flaps for moderate-sized back defects.

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The application of keystone flap combined with vacuum‐assisted closure in the repair of sacrococcygeal skin defect after tumor resection

Cited by 5 publications

References 21 publications

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap

Successful Reconstruction of Complex Sacrococcygeal Defects Using Chimeric Perforator Propeller Flap

Simplified and modified Limberg flap plus vacuum‐assisted closure for treatment of sacrococcygeal pilonidal sinus disease

Outcomes of the keystone perforator island flap for oncologic reconstruction of the back

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