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.	蔣麗雅, 劉元波, 臧夢青, 等. 以旋股外側動脈斜支為蒂的逆行股前外側皮瓣臨床應用研究. 中國修復重建外科雜志, 2017, 31(5): 559-563.
3.	朱躍良, 殷作明, 王家祥, 等. 股前外側穿支皮瓣切取技巧分析. 中國修復重建外科雜志, 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.	鄒平志, 劉斌, 姜任武, 等. 改良拱頂石皮瓣在頭皮軟組織缺損修復中的應用. 中國美容整形外科雜志, 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, 楊超, 邢新, 等. 改良拱頂石穿支島狀皮瓣在肛周缺損修復中的應用. 中國美容整形外科雜志, 2016, 27(9): 532-535.
8.	劉偉峰, 劉斌, 姜任武, 等. 拱頂石皮瓣在足部皮膚軟組織缺損修復中的應用. 中國美容整形外科雜志, 2016, 27(10): 622-623.
9.	楊超, 邢新, 徐建國, 等. 拱頂石穿支島狀皮瓣在皮膚軟組織缺損修復中的應用. 中華整形外科雜志, 2014, 30(1): 10-13.
10.	方碩, 楊超, 邢新. 拱頂石穿支島狀皮瓣. 中華整形外科雜志, 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.	張世民, 宋達疆. 穿支皮瓣的發現發展歷史與臨床啟示. 中國修復重建外科雜志, 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.	曾進強, 李龍, 周華喬, 等. 負壓封閉引流技術與傳統換藥術在軟組織損傷修復中的臨床療效及安全性對比研究. 臨床醫學工程, 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.	黎曉華, 王惠東, 張長青, 等. 封閉式負壓引流技術聯合皮瓣修復下肢皮膚軟組織缺損. 中國修復重建外科雜志, 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. 蔣麗雅, 劉元波, 臧夢青, 等. 以旋股外側動脈斜支為蒂的逆行股前外側皮瓣臨床應用研究. 中國修復重建外科雜志, 2017, 31(5): 559-563.
3. 朱躍良, 殷作明, 王家祥, 等. 股前外側穿支皮瓣切取技巧分析. 中國修復重建外科雜志, 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. 鄒平志, 劉斌, 姜任武, 等. 改良拱頂石皮瓣在頭皮軟組織缺損修復中的應用. 中國美容整形外科雜志, 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, 楊超, 邢新, 等. 改良拱頂石穿支島狀皮瓣在肛周缺損修復中的應用. 中國美容整形外科雜志, 2016, 27(9): 532-535.
8. 劉偉峰, 劉斌, 姜任武, 等. 拱頂石皮瓣在足部皮膚軟組織缺損修復中的應用. 中國美容整形外科雜志, 2016, 27(10): 622-623.
9. 楊超, 邢新, 徐建國, 等. 拱頂石穿支島狀皮瓣在皮膚軟組織缺損修復中的應用. 中華整形外科雜志, 2014, 30(1): 10-13.
10. 方碩, 楊超, 邢新. 拱頂石穿支島狀皮瓣. 中華整形外科雜志, 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. 張世民, 宋達疆. 穿支皮瓣的發現發展歷史與臨床啟示. 中國修復重建外科雜志, 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. 曾進強, 李龍, 周華喬, 等. 負壓封閉引流技術與傳統換藥術在軟組織損傷修復中的臨床療效及安全性對比研究. 臨床醫學工程, 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. 黎曉華, 王惠東, 張長青, 等. 封閉式負壓引流技術聯合皮瓣修復下肢皮膚軟組織缺損. 中國修復重建外科雜志, 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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