Comparison of Keystone Flaps and Skin Grafts for Oncologic Reconstruction: a Retrospective Review
George Kokosis, Halley Darach, BS, Jill P. Stone, MD, Kelly Bridgham, BS, Julie Lange, MD, Justin M. Sacks, MD, MBA, FACS.
Johns Hopkins University, Baltimore, MD, USA.
Two common options for the closure of complex defects include local flaps and skin grafting. The keystone flap, a fasciocutaneous flap based on natural perforators, has demonstrated compelling ease of use, reproducibility, and complication rates without requiring a distant donor site. However, there has been little comparison of these two methods' indications and outcomes. METHODS: A retrospective review was conducted of patients undergoing keystone flap closure or skin grafting following cancer resection at our institution from June 2017 to May 2018. Patient demographics, operative indications, length of stay, time to heal, and postoperative course were reviewed. RESULTS: 16 keystone and 18 skin grafts were identified were identified in 34 patients following oncologic resection. 14 keystones and 16 skin-grafts patients were following skin cancer resection, while the remaining 2 keystones and skin grafts were following sarcoma resection. Of the 18 skin grafts, 12 were harvested as split thickness and 6 as full thickness. Compared to skin grafts, patients undergoing keystone flap reconstruction had significantly shorter mobility restriction (p=0.0015) and healing times (2.15 mo vs. 3.49 mo, p=0.008). Two skin graft patients experienced donor site complications (ulceration and persistent itching), which both resolved by 4 months postop. Length of hospital stay was shorter and overall complication rates were fewer in the keystone flap group, however these were not significantly different. CONCLUSIONS:
The keystone fasciocutaneous flap is a versatile flap that can be safely used for coverage of complex defects with high degree of success. The ease of harvest, sensate coverage, and elimination of a donor site renders the keystone flap a valuable option for the plastic surgeon. In our study the keystone flap successfully covered defects with faster healing, shorter mobility restriction, and comparable complication rates to skin grafting.
Back to 2018 Abstracts