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- Presentation
Getting a Leg Up is Never Easy: Discover Novel Ways to Approach Reconstruction of the Leg, Ankle and Foot: Keystone Flaps
Description
The presentation discusses the Keystone Island perforator flap, introduced by Felix Bahan in 2003, highlighting its effectiveness in reconstructing the leg, ankle, and foot. The flap's trapezoidal shape mimics a Roman arch keystone, which allows for efficient tissue movement and healing. The speaker explains three variants of the Keystone flap—type 1, type 2, and type 3—detailing their design and implementation based on the size of the wound. The flaps rely on perforating arteries for blood supply, making their vascularization robust and promoting survival rates of around 98%. The technique involves converting circular defects into linear repairs, designing trapezoidal flaps, and advancing them to cover defects without significant undermining, which leads to reduced pain and quick recovery. Clinical examples demonstrate the flap's versatility in different high-tension areas like the leg and upper body. The speaker recommends using longer-lasting sutures for lower extremity defects and notes minimal pain and high satisfaction in patients post-surgery. Additionally, a flexible approach towards postoperative activity restrictions is advocated, supporting patient autonomy while healing.
View moreConclusions
- The Keystone Island perforator flap is a valuable technique for soft tissue reconstruction in various locations, especially the lower leg.
- Keystone flaps demonstrate high survival rates, with reported success rates of 98% across various studies.
- The design and execution of Keystone flaps are relatively straightforward, making them an accessible option for surgical reconstruction.
- Healing with Keystone flaps is generally efficient, leading to minimal postoperative pain and rapid recovery of sensation in the flap area.
- The vascularity of Keystone flaps is enhanced by the circumferential incision that may increase arterial supply, beneficial for tissue survivability.
- Different variants of Keystone flaps allow for tailored approaches depending on the size and location of the tissue defect.
- Further standardization of reporting and surgical guidelines is needed to optimize patient-specific planning and outcomes.
- These flaps can be executed without significant undermining, reducing complications often associated with more invasive flap techniques.
- World J Clin Cases. May 26, 2020; 8(10): 1832-1847. doi: 10.12998/wjcc.v8.i10.1832
- Clin Plastic Surg 37 (2010) 553-570 doi:10.1016/j.cps.2010.06.006
- J Reconstr Microsurg 2022;38:727-733.
- lournal of Reconstructive Microsurgery Vol. 38 No. 9/2022 2022. Thieme. All rights reserved.
- Mohan, Anita T. M.R.C.S ., B.Sc .; Rammos, Charalambos K. M.D .; Akhavan, Arya A. B.S .; Martinez, Jorys M.D .; Wu, Peter S. M.D .; Moran, Steven L. M.D .; Sim, Franklin H. M.D .; Behan, Felix F.R.C.S ., F.R.A.C.S .; Mardini, Samir M.D .; Saint-Cyr, Michel M.D.