The keystone design perforator island flap in reconstructive surgery

Abstract

To introduce the experience in skin defects reconstruction using keystone design perforator island flap. Since June 2012 to June 2013, the flaps have been used in 14 patients. The size of defects ranged from 1 cm x 1 cm to 5 cm x 9 cm at the extremities, trunk and facial region. The trapezoidal shaped flap has the same width as the defect. The flap is designed along the edge of the defect with 90 degree angle at the ends of the island flap. This curvilinear- and trapezoidal-shaped flap essentially consists of two conjoined V-Y advancement flaps at the proximal and distal end. The vascular supply is supported by the subcutaneous vascular network and fascial/muscular perforators. Perforators should be detected by Doppler techniques when large size flaps are used. Primary wound healing and satisfactory result was achieved in 13 patients except for one with partial flap necrosis. The technique offers a simple and effective method of wound closure in situations that would otherwise have required complex flap closure or skin grafting.