The keystone flap: A multi-centric experience in elderly patients treatment

• DOI: 10.1016/j.bjps.2021.08.043
• Publication Date: 2021-09-20T02:19:17Z
• Authors: Federico Lo Torto; Jacopo M Frattaroli; Juste Kaciulyte; Francesco L.R. Mori; Luigi Troisi; Pedro Ciudad; Oscar J. Manrique; Marco Marcasciano; Giorgio E. Pajardi; Donato Casella; Emanuele Cigna; Diego Ribuffo
• Keywords: Soft tissue reconstruction; Extremities; Keystone flap; Skin Transplantation; Plastic Surgery Procedures; Surgical Flaps; 3. Good health; Surgical Flap; Elderly patient; Keystone flap; Soft tissue reconstruction; 03 medical and health sciences; Treatment Outcome; 0302 clinical medicine; Retrospective Studie; Humans; Reconstructive Surgical Procedures; Elderly patient; Extremitie; Human; Elderly patient; Keystone flap; Soft tissue reconstruction; Aged; Extremities; Humans; Retrospective Studies; Skin Transplantation; Surgical Flaps; Treatment Outcome; Reconstructive Surgical Procedures; Aged; Retrospective Studies

Soft tissue reconstruction in elderly patients must be rapid and reliable. The keystone island flap (KF) offers an effective solution, with low complication rates and quick recovery. This multi-centric study aims to show authors' experience with KFs in treating soft tissue defects of trunk and limbs. Patients with soft tissue defects suitable for KF reconstruction were recruited from March 2019 to December 2019. Active inflammation and previous surgeries in the same region were considered exclusion criteria. Complications that occurred during follow-up were recorded, and their incidence pattern was assessed with the Fisher test. Seventy-two patients with mean age of 76.2 years old were selected. They presented lesions in torso (46; 63.9%) or in upper (4; 5.6%) or lower (22; 30.6%) limb regions. Fifteen (20.8%) wounds were non-oncologic lesions, and the others were oncologic lesions, mostly non-melanoma skin cancers. KF type I was carried out in 42 (58.3%) cases, KF type II-A in 13 (18%) cases, double opposed type III KF in 16 (22.2%) patients, and 1 (1.4%) case required partial flap's undermining (IV KF). Mean post-operative recovery period was 4.3 days (range, 1-9 days). Post-surgical complications occurred in 15 (20.8%) cases, 7 (9.7%) of them were considered major complications. No statistically significant difference in complications' incidence, nor among different surgical sites nor among KF types, was registered. Reconstructive surgeons have to adapt their work to elderly patients. The KF allows rapid operative times, low morbidity rates, and short post-operative recovery time, thus appearing as a feasible solution.