Archives of Plastic Surgery

Korean Society of Plastic and Reconstructive Surgeons (대한성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

A systematic review of the keystone design perforator island flap in the reconstruction of trunk defects

  • Rini, Irena Sakura (Department of Plastic Surgery, Dharmais Cancer Hospital) ;
  • Gunardi, Alberta Jesslyn (Department of Plastic Surgery, Dharmais Cancer Hospital) ;
  • Marsaulina, Renate Parlene (Department of Plastic Surgery, Dharmais Cancer Hospital) ;
  • Aryandono, Teguh (Division of Oncology Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada) ;
  • Dachlan, Ishandono (Division of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada) ;
  • Dwiprahasto, Iwan (Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada)
  • Received : 2020.01.17
  • Accepted : 2020.07.15
  • Published : 2020.11.15
Download PDF
⟨ Previous Next ⟩

Abstract

The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.

Keywords

References

  1. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 2003;73:112-20. https://doi.org/10.1046/j.1445-2197.2003.02638.x
  2. Bhat SP. Keystone flaps in coloured skin: flap technology for the masses? Indian J Plast Surg 2013;46:36-47. https://doi.org/10.4103/0970-0358.113705
  3. Behan FC, Rozen WM, Lo CH, et al. The omega - $\Omega$ - variant designs (types A and B) of the keystone perforator island flap. ANZ J Surg 2011;81:650-2. https://doi.org/10.1111/j.1445-2197.2011.05833.x
  4. Donaldson C, Murday HK, Gutman MJ, et al. Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 2018;34:733-6. https://doi.org/10.1007/s00381-017-3697-2
  5. Khouri JS, Egeland BM, Daily SD, et al. The keystone island flap: use in large defects of the trunk and extremities in soft-tissue reconstruction. Plast Reconstr Surg 2011;127:1212-21. https://doi.org/10.1097/PRS.0b013e318205f36f
  6. Huang J, Yu N, Long X, et al. A systematic review of the keystone design perforator island flap in lower extremity defects. Medicine (Baltimore) 2017;96:e6842. https://doi.org/10.1097/MD.0000000000006842
  7. Moher D, Liberati A, Tetzlaff J, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010;8:336-41. https://doi.org/10.1016/j.ijsu.2010.02.007
  8. Pelissier P, Gardet H, Pinsolle V, et al. The keystone design perforator island flap. Part II: clinical applications. J Plast Reconstr Aesthet Surg 2007;60:888-91. https://doi.org/10.1016/j.bjps.2007.03.023
  9. Stone JP, Webb C, McKinnon JG, et al. Avoiding skin grafts: the keystone flap in cutaneous defects. Plast Reconstr Surg 2015;136:404-8. https://doi.org/10.1097/PRS.0000000000001449
  10. Park HS, Morrison E, Lo C, et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg 2016;77:332-6. https://doi.org/10.1097/SAP.0000000000000600
  11. Mohan AT, Rammos CK, Akhavan AA, et al. Evolving concepts of keystone perforator island flaps (KPIF): principles of perforator anatomy, design modifications, and extended clinical applications. Plast Reconstr Surg 2016;137:1909-20. https://doi.org/10.1097/PRS.0000000000002228
  12. Lanni MA, Van Kouwenberg E, Yan A, et al. Applying the keystone design perforator island flap concept in a variety of anatomic locations: a review of 60 consecutive cases by a single surgeon. Ann Plast Surg 2017;79:60-7. https://doi.org/10.1097/SAP.0000000000000995
  13. Park TH, Lee JW, Kim CW. The fortune cookie flap for aesthetic reconstruction after chest keloid resection: a small case series. J Cardiothorac Surg 2018;13:31. https://doi.org/10.1186/s13019-018-0713-x
  14. Behr B, Wagner JM, Wallner C, et al. Reconstructive options for oncologic posterior trunk defects: a review. Front Oncol 2016;6:51.
  15. Hamdi M, Stillaert FB. Pedicled perforator flaps in the trunk. Clin Plast Surg 2010;37:655-65. https://doi.org/10.1016/j.cps.2010.06.004
  16. Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988;81:561-6. https://doi.org/10.1097/00006534-198804000-00012
  17. Correia B, Costa J, Casanov J, et al. The keystone perforator island flap and its use in complex defects of the trunk: a case report. Rev Port Cir Cardiotorac Vasc 2017;24:77-9.
  18. Lazzeri D, Huemer GM, Nicoli F, et al. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: a systematic review. Arch Plast Surg 2013;40:44-50. https://doi.org/10.5999/aps.2013.40.1.44
  19. Bui DT, Cordeiro PG, Hu QY, et al. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007;119:2092-100. https://doi.org/10.1097/01.prs.0000260598.24376.e1
  20. Chang EI. My first 100 consecutive microvascular free flaps: pearls and lessons learned in first year of practice. Plast Reconstr Surg Glob Open 2013;1:e27. https://doi.org/10.1097/GOX.0b013e31829e1007
  21. Pignatti M, Pasqualini M, Governa M, et al. Propeller flaps for leg reconstruction. J Plast Reconstr Aesthet Surg 2008; 61:777-83. https://doi.org/10.1016/j.bjps.2007.10.077
  22. Bravo FG, Schwarze HP. Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthet Surg 2009;62:602-9. https://doi.org/10.1016/j.bjps.2008.11.086
  23. Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg 2009;123:230-5. https://doi.org/10.1097/PRS.0b013e3181904dc4
  24. Kneser U, Beier JP, Schmitz M, et al. Zonal perfusion patterns in pedicled free-style perforator flaps. J Plast Reconstr Aesthet Surg 2014;67:e9-17. https://doi.org/10.1016/j.bjps.2013.09.006
  25. Pignatti M, Ogawa R, Hallock GG, et al. The "Tokyo" consensus on propeller flaps. Plast Reconstr Surg 2011;127: 716-22. https://doi.org/10.1097/PRS.0b013e3181fed6b2
  26. Bekara F, Herlin C, Mojallal A, et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: identification of risk factors for complications. Plast Reconstr Surg 2016;137:314-31. https://doi.org/10.1097/PRS.0000000000001891

Cited by

  1. Outcomes of the keystone perforator island flap for oncologic reconstruction of the back vol.124, pp.7, 2020, https://doi.org/10.1002/jso.26629
  2. Comparison of the Keystone flap and the Limberg flap technique in the surgical treatment of pilonidal sinus disease vol.73, pp.6, 2020, https://doi.org/10.1007/s13304-021-01153-w