Application of modified keystone flap in repairing of skin and soft tissue defect around joint_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

WU Minliang , GUO Rui ^Δ , DAI Haiying , XU Jianguo , SUN Mengyan , WANG Xinwei , YU Hao ,  WANG Yuchong ,  XUE Chunyu

Department of Plastic Surgery, Changhai Hospital, Naval Medical University, Shanghai, 200433, P.R.China;

Corresponding author：

WANG Yuchong, Email: drwangyc@163.com; XUE Chunyu, Email: xcyfun@sina.com

Keywords：

Keystone flap; modified flap; joint; wound repair

DOI：

10.7507/1002-1892.201812004

Video：

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Objective To explore the effectiveness of keystone flap in repairing skin and soft tissue defects around joint.Methods Between March 2013 and December 2017, 10 patients of skin and soft tissue defects around the joint were repaired with keystone flaps. There were 6 males and 4 females. The age ranged from 17 to 72 years, with an average age of 57.5 years. The skin and soft tissue defects located around the joints, including 2 cases of hip joints, 4 cases of knee joints, 3 cases of elbow joints, and 1 case of wrist joint. The cause of skin and soft tissue defects included scar contracture in 3 cases, basal cell carcinoma in 3 cases, squamous-cell carcinoma in 3 cases, and dermatofibrosarcoma protuberant in 1 case. The area of defects ranged from 4 cm×3 cm to 11 cm×11 cm. The keystone flap was designed beside the wound, and the V-shaped flap was designed at the longer side of the fan-shaped flap. The area of flap ranged from 7 cm×3 cm to 35 cm×10 cm. The flap was constantly compressed by vacuum assisted closure after operation for 3-6 days.Results Primary wound healing was achieved and the flaps survived. All patients were followed up 6-24 months (mean, 15 months). The texture and color of flap was similar to the adjacent area. The appearance and function of joint were satisfactory.Conclusion The keystone flap is a feasible and efficient way to repair the wound around joint. Furthermore, the skin color and texture is similar to the surrounding tissue after healing.

Citation： WU Minliang, GUO Rui, DAI Haiying, XU Jianguo, SUN Mengyan, WANG Xinwei, YU Hao, WANG Yuchong, XUE Chunyu. Application of modified keystone flap in repairing of skin and soft tissue defect around joint. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(4): 471-474. doi: 10.7507/1002-1892.201812004 Copy

1.	Shin YH, Hwang PJ, Hwang K. V-Y and rotation flap for reconstruction of the epicanthal fold. J Craniofac Surg, 2012, 23(4): e278-e280.
2.	蒋丽雅, 刘元波, 臧梦青, 等. 以旋股外侧动脉斜支为蒂的逆行股前外侧皮瓣临床应用研究. 中国修复重建外科杂志, 2017, 31(5): 559-563.
3.	朱跃良, 殷作明, 王家祥, 等. 股前外侧穿支皮瓣切取技巧分析. 中国修复重建外科杂志, 2017, 31(1): 57-61.
4.	Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg, 2003, 73(3): 112-120.
5.	邹平志, 刘斌, 姜任武, 等. 改良拱顶石皮瓣在头皮软组织缺损修复中的应用. 中国美容整形外科杂志, 2017, 28(10): 602-603.
6.	Park HS, Morrison E, Lo C, et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg, 2015, 77(3): 332-336.
7.	沈頔, 杨超, 邢新, 等. 改良拱顶石穿支岛状皮瓣在肛周缺损修复中的应用. 中国美容整形外科杂志, 2016, 27(9): 532-535.
8.	刘伟峰, 刘斌, 姜任武, 等. 拱顶石皮瓣在足部皮肤软组织缺损修复中的应用. 中国美容整形外科杂志, 2016, 27(10): 622-623.
9.	杨超, 邢新, 徐建国, 等. 拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用. 中华整形外科杂志, 2014, 30(1): 10-13.
10.	方硕, 杨超, 邢新. 拱顶石穿支岛状皮瓣. 中华整形外科杂志, 2013, 29(6): 472-476.
11.	Douglas CD, Low NC, Seitz MJ. The keystone flap: not an advance, just a stretch. Ann Surg Oncol, 2013, 20(3): 973-980.
12.	张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
13.	Moncrieff MD, Thompson JF, Stretch JR. Extended experience and modifications in the design and concepts of the keystone design island flap. J Plast Reconstr Aesthet Surg, 2010, 63(8): 1359-1363.
14.	Monarca C, Rizzo MI, Sanese G. Keystone flap: freestyle technique to enhance the mobility of the flap. ANZ J Surg, 2012, 82(12): 950-951.
15.	Rao K, Raine C. Re: keystone design flap: a tension-reducing modification. ANZ J Surg, 2010, 80(7-8): 574.
16.	曾进强, 李龙, 周华乔, 等. 负压封闭引流技术与传统换药术在软组织损伤修复中的临床疗效及安全性对比研究. 临床医学工程, 2016, 23(2): 189-190.
17.	Borgquist O, Ingemansson R, Malmsjo M. Wound edge microvascular blood flow during negative-pressure wound therapy: examining the effects of pressures from –10 to –175 mmHg. Plast Reconstr Surg, 2010, 125(2): 502-509.
18.	黎晓华, 王惠东, 张长青, 等. 封闭式负压引流技术联合皮瓣修复下肢皮肤软组织缺损. 中国修复重建外科杂志, 2010, 24(6): 722-725.
19.	Wu M, Sun M, Dai H, et al. Negative-pressure wound therapy: An effective adjunctive treatment to assist flap survival and wound closure. J Plast Reconstr Aesthet Surg, 2018, 71(11): 1664-1678.

1. Shin YH, Hwang PJ, Hwang K. V-Y and rotation flap for reconstruction of the epicanthal fold. J Craniofac Surg, 2012, 23(4): e278-e280.
2. 蒋丽雅, 刘元波, 臧梦青, 等. 以旋股外侧动脉斜支为蒂的逆行股前外侧皮瓣临床应用研究. 中国修复重建外科杂志, 2017, 31(5): 559-563.
3. 朱跃良, 殷作明, 王家祥, 等. 股前外侧穿支皮瓣切取技巧分析. 中国修复重建外科杂志, 2017, 31(1): 57-61.
4. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg, 2003, 73(3): 112-120.
5. 邹平志, 刘斌, 姜任武, 等. 改良拱顶石皮瓣在头皮软组织缺损修复中的应用. 中国美容整形外科杂志, 2017, 28(10): 602-603.
6. Park HS, Morrison E, Lo C, et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg, 2015, 77(3): 332-336.
7. 沈頔, 杨超, 邢新, 等. 改良拱顶石穿支岛状皮瓣在肛周缺损修复中的应用. 中国美容整形外科杂志, 2016, 27(9): 532-535.
8. 刘伟峰, 刘斌, 姜任武, 等. 拱顶石皮瓣在足部皮肤软组织缺损修复中的应用. 中国美容整形外科杂志, 2016, 27(10): 622-623.
9. 杨超, 邢新, 徐建国, 等. 拱顶石穿支岛状皮瓣在皮肤软组织缺损修复中的应用. 中华整形外科杂志, 2014, 30(1): 10-13.
10. 方硕, 杨超, 邢新. 拱顶石穿支岛状皮瓣. 中华整形外科杂志, 2013, 29(6): 472-476.
11. Douglas CD, Low NC, Seitz MJ. The keystone flap: not an advance, just a stretch. Ann Surg Oncol, 2013, 20(3): 973-980.
12. 张世民, 宋达疆. 穿支皮瓣的发现发展历史与临床启示. 中国修复重建外科杂志, 2017, 31(7): 769-772.
13. Moncrieff MD, Thompson JF, Stretch JR. Extended experience and modifications in the design and concepts of the keystone design island flap. J Plast Reconstr Aesthet Surg, 2010, 63(8): 1359-1363.
14. Monarca C, Rizzo MI, Sanese G. Keystone flap: freestyle technique to enhance the mobility of the flap. ANZ J Surg, 2012, 82(12): 950-951.
15. Rao K, Raine C. Re: keystone design flap: a tension-reducing modification. ANZ J Surg, 2010, 80(7-8): 574.
16. 曾进强, 李龙, 周华乔, 等. 负压封闭引流技术与传统换药术在软组织损伤修复中的临床疗效及安全性对比研究. 临床医学工程, 2016, 23(2): 189-190.
17. Borgquist O, Ingemansson R, Malmsjo M. Wound edge microvascular blood flow during negative-pressure wound therapy: examining the effects of pressures from –10 to –175 mmHg. Plast Reconstr Surg, 2010, 125(2): 502-509.
18. 黎晓华, 王惠东, 张长青, 等. 封闭式负压引流技术联合皮瓣修复下肢皮肤软组织缺损. 中国修复重建外科杂志, 2010, 24(6): 722-725.
19. Wu M, Sun M, Dai H, et al. Negative-pressure wound therapy: An effective adjunctive treatment to assist flap survival and wound closure. J Plast Reconstr Aesthet Surg, 2018, 71(11): 1664-1678.

Chinese Journal of Reparative and Reconstructive Surgery

Application of modified keystone flap in repairing of skin and soft tissue defect around joint

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