Assessment of Survival of Keystone Perforator Flap
DOI:
https://doi.org/10.51253/pafmj.v73i6.10196Keywords:
Keystone perforator flap, Self-harm, Shearing forcesAbstract
Objective: To assess the single most important factor affecting the survival of keystone perforator flap.
Study Design: Case series.
Place and Duration of Study: Combined Military Hospital, Quetta Pakistan, from Mar 2021 to Sep 2022.
Methodology: Patients presenting at Plastic Surgery OPD, where resultant wound defects were covered by a keystone
perforator flap for wound coverage, above ten years of age were included in the study. They also included proximal forearm
self-harm patients. Operated patients were followed up post-operatively for three weeks, and success and complications were noted. The single most important factor for flap complication was noted.
Results: Eleven patients were studied that fulfilled the inclusion criteria. The age range was 11-59 years. Two were cases of
pilonidal sinus, 1 was squamous cell carcinoma (SCC) forearm, and 1 was carbuncle back. All the remaining 7 were of selfharm scars/ wounds of the proximal forearm. Two patients developed partial peripheral flap necrosis that later healed with granulation tissue. The reason for partial flap necrosis was recognized to be shearing forces due to early/excessive post-op mobilization.
Conclusion: The keystone perforator flap transposes pliable adjacent tissue, giving the patient the same look and skin texture as the original tissue. The most important factor affecting flap survival in this small case series was shearing forces, and measures to immobilize the operation site could improve results.
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Behan C. The keystone design perforator island flap in
Reconstructive surgery. ANZ J surg 2003; 73: 112–120.
https://doi.org/10.1046/j.1445-2197.2003.02638.x
Yoon CS, Kim HB, Kim YK. Relaxed skin tension line–oriented
keystone–designed perforator island flaps considering the facial
aesthetic unit concept for the coverage of small to moderate
facial defects. Medicine (Baltimore) 2019; 98: e14167.
https://doi.org/10.1097%2FMD.0000000000014167
Aithal S, Loganathan E, Shekar R. Keystone Island Flap for
Reconstructive Surgery - A Novel Approach. J Cutaneous
Aesthet Surg 2022 15(3): 315-318.
https://doi.org/10.4103%2FJCAS.JCAS_167_21
Gordon T, Golin AP, Anzarut A. Keystone Flap for Closure of
Skin Cancer Defects on the Upper Extremity. Plastic Surgery.
https://doi.org/10.1177/22925503221094106
Khouri JS, Egeland BM, Daily SD, Harake MS. The keystone
island flap: use in large defects of the trunk and extremities in
soft-tissue reconstruction. Plast Reconstr Surg 2011; 127: 1212-
https://doi.org/10.1097/prs.0b013e318205f36f
Pignatti M, Pasqualini M, Rigotti G. Propeller flaps for leg
reconstruction. J Plast Reconstr Aesthet Surg 2008; 61(1): 777–
https://doi.org/10.1016/j.bjps.2007.10.077
Coid J, Wilkins J, Coid B, Everitt B. Self-mutilation in female
remanded prisoners II: A cluster analytic approach towards
identification of a behavioural syndrome. Crim Behav Ment
Health 1992; 2: 1–14.
Favazza AR, Conterio K. Female habitual self-mutilators.
Acta Psychiatr Scand 1989; 79(3): 283–289.
https://doi.org/10.1111/j.1600-0447.1989.tb10259.x
Jacobson CM, Gould M. The epidemiology and phenomenology
of non-suicidal self-injurious behavior among adolescents: A
critical review of the literature. Arch Suicide Res 2007; 11(2): 129–
https://doi.org/10.1080/13811110701247602
Jones JG, Cohen AL, Worley KB, Worthington T. Accidental
scratch - or a sign of self-cutting? J Fam Pract 2015; 64(5): 277-281.
Fujioka M, Murakami C, Masuda K, Doi H. Evaluation of
superficial and deep self-inflicted wrist and forearm lacerations.
J Hand Surg Am 2012; 37(5): 1054-1058.
https://doi.org/10.1016/j.jhsa.2011.12.040
Ahluwalia J, Lowenstein EJ. Case study: delicate skin cutting:
management beyond the skin and implications of superficial
habitual self-mutilation. Skinmed 2005; 4(3): 190-192.
https://doi.org/10.1111/j.1540-9740.2005.04255.x
Schroeder M, Eberlein C, de Zwaan M, Lower levels of
cannabinoid 1 receptor mRNA in female eating disorder patients:
association with wrist cutting as impulsive self-injurious
behavior. Psychoneuroendocrinology 2012; 37(12): 2032-2036.
https://doi.org/10.1016/j.psyneuen.2012.03.025
Rini IR, Gunardi AJ, Marsaulina RP, Aryandono T, Dachlan I,
Dwiprahasto I, et al. A systematic review of the keystone
design perforator island flap in the reconstruction of trunk
defects. Arch Plast Surg 2020; 47(6): 535–541.
https://doi.org/10.5999/aps.2020.00094.
Weinberg M, Heiman AJ, DeSanti R, Lanni MA, Kouwenberg
EV, Patel A, et al. Outcomes of the keystone island perforator
flap: a systematic review. J Reconstr Microsurg 2022; 38(09): 727-
https://doi.org/10.1055/s-0042-1745744
Potet P Bonnecaze GD, Chabrillac E, Dupret-Bories A, Vergez S,
Chaput B, et al. Closure of radial forearm free Oap donor site: A
comparative study between keystone flap and skin graft. Head
Neck 2020 : 42 (2): 217-223. https://doi.org/10.1002/hed.25977
Zuidam JM, Coert JH, Hofer SOP. Closure of the donor
site of the free radial foreann flap: a comparison of full
thickness graft and Split thickness skin graft. Ann Plast Surg
; 55(6): 612-616
https://doi.org/10.1097/01.sap.0000185656.66239.ad
Wester JL, Pittman AL, Lindau RH, Wax MK. AlloDerm with
Split thickness skin graft for coverage of the foreann free flap
donor site. Otolaryngol Head Neck Surg J 2014; 150(1): 47-52.
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