Colin P White
Surrey Memorial Hospital, Canada
Title: The keystone flap – Practical design, use and diverse applications
Biography
Biography: Colin P White
Abstract
Introduction & Aims: We documented our clinical experience using the keystone flap for various different defects over the body. We review the advantages and disadvantages of the keystone flap as well as technical pearls with regards to raising the flap and some of its modifications. Methods: We show a case series of 16 patients all of whom have had skin cancer resections (sizes 2x2 cm to 6x6 cm, mean=3x3 cm). All of these patients are shown with surgical images to exemplify the diversity of the reconstructions. All of the flaps survived with the most common complication being minor crusting at the suture lines. Results: Based on our clinical experience, the keystone flap avoids tension on a closure. Donor skin graft sites are avoided, and thus there is no donor site care or pain. Keystone flaps avoid extremity splinting and they avoid the need for prolonged dressing care for partially healed wounds. There are better long term surgery site aesthetics compared to skin grafting. The drawbacks include the fact that a larger initial surgical area is needed and that the keystone flap requires more surgical time for suturing. Conclusion: The keystone flap is an excellent reconstruction for full thickness skin defects from skin cancer resection all over the body. We conclude that it can be used reliably on the lower extremity, trunk, hand, calf and scalp