Wound Healing Society

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Customized Reconstruction With Modified Keystone Flaps
Tae Hwan Park.
Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University College of Medicine, Seongnam, Republic of Korea, Seongnam, Korea, Republic of.

Background The reconstruction of soft tissue defects with a similar type of tissue and minimizing morbidities are important. Here we describe our surgical experience using customized reconstruction with keystone design flap variants created from tissue adjacent to surgical defects. Methods We retrospectively reviewed a data of 48 consecutive soft tissue reconstruction using keystone design flap variants between March 2017 and December 2017. Results Soft tissue reconstruction was performed and there was no major complication in the follow-up period. The dimensions of the wound defect ranged from 1 x 1 cm2 to 15 x 15 cm2 with a mean size of 4.7 x 3.5 cm2, while the dimensions of the customized keystone design flap ranged from 2 x 1 cm2 to 18 x 15 cm2 with a mean size of 6.9 x 4.4 cm2. Minor dehiscence in 3 cases (6%) and partial flap loss in 1 case (2%) were noticed. Two cases were healed spontaneously and other two cases were reconstructed with contralateral mini keystone design flap or split-thickness skin grafting. All patients were satisfied with the aesthetic outcomes. Conclusions Due to its simple design, reliability, versatility, minimal donor-site morbidity, and excellent cosmesis, our customized keystone design flaps could be reasonable surgical options in various clinical circumstances.

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