Utility of Keystone Flap in Armory of Dermatosurgeons

Purpose and background: To create awareness among dermatosurgeons about the versatility of keystone flaps in re-surfacing post-excisional small, medium and large skin defects.

Aims and objectives: Single-staged tension-free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome.

Material and methods: This retrospective study was conducted, between October 2021 - January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years. Sixteen Keystone flaps (type IIA n=13, Omega cum Sydney melanoma unit modification n=3) were utilized for resurfacing skin defects arising after excision of basal cell carcinoma (n=3) and benign hairy nevus (n=2) on cheek, basal cell carcinoma forehead (n=1), electric burns on deltoid (n=2), giant neurofibroma back (n=1), tattoo forearm (n=3), chronic non-specific granuloma thumb (n=2) and pilonidal sinus disease (n=2). Skin with maximum expansibility was chosen as donor site with utmost care of facial lines and its aesthetic subunits. Flaps were dissected all around preserving maximum number of hand-held Doppler-identified perforators in pedicular area. Sutures were removed on 10th to 15th post-operative day. Follow-ups ranged from 2 to 15 months.

Results: None had wound dehiscence or loss of flap.

Conclusion: Keystone flaps have defect-adaptive design, simple bio-geometry, technical simplicity, decreased downtime, cost effectivity and efficiency and can be designed to resurface post-excisional skin defect from head to toe with acceptable results, therefore should strongly be considered by dermatosurgeons while excising skin lesions.