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CC BY-NC 4.0 · Arch Plast Surg 2020; 47(06): 535-541
DOI: 10.5999/aps.2020.00094
Review Article

A systematic review of the keystone design perforator island flap in the reconstruction of trunk defects

Irena Sakura Rini 
Department of Plastic Surgery, Dharmais Cancer Hospital, West Jakarta, Indonesia
,
Alberta Jesslyn Gunardi 
Department of Plastic Surgery, Dharmais Cancer Hospital, West Jakarta, Indonesia
,
Renate Parlene Marsaulina 
Department of Plastic Surgery, Dharmais Cancer Hospital, West Jakarta, Indonesia
,
Teguh Aryandono 
Divisions of Oncology Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
,
Ishandono Dachlan 
Divisions of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
,
Iwan Dwiprahasto 
Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia
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The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.

Keywords

Perforator flap - Reconstructive surgical procedures - Torso - Systematic review

This article was presented at the PRS Korea on November 8–10, 2019, in Seoul, Korea.




Publication History

Received: 17 January 2020

Accepted: 15 July 2020

Article published online:
25 March 2022

© 2020. The Korean Society of Plastic and Reconstructive Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonCommercial License, permitting unrestricted noncommercial use, distribution, and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes. (https://creativecommons.org/licenses/by-nc/4.0/)

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  • REFERENCES

  • 1 Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg 2003; 73: 112-20
    CrossrefPubMedGoogle Scholar
  • 2 Bhat SP. Keystone flaps in coloured skin: flap technology for the masses?. Indian J Plast Surg 2013; 46: 36-47
    CrossrefPubMedGoogle Scholar
  • 3 Behan FC, Rozen WM, Lo CH. et al. The omega - Ω - variant designs (types A and B) of the keystone perforator island flap. ANZ J Surg 2011; 81: 650-2
    PubMedGoogle Scholar
  • 4 Donaldson C, Murday HK, Gutman MJ. et al. Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele. Childs Nerv Syst 2018; 34: 733-6
    CrossrefPubMedGoogle Scholar
  • 5 Khouri JS, Egeland BM, Daily SD. et al. The keystone island flap: use in large defects of the trunk and extremities in soft-tissue reconstruction. Plast Reconstr Surg 2011; 127: 1212-21
    CrossrefPubMedGoogle Scholar
  • 6 Huang J, Yu N, Long X. et al. A systematic review of the keystone design perforator island flap in lower extremity defects. Medicine (Baltimore) 2017; 96: e6842
    CrossrefPubMedGoogle Scholar
  • 7 Moher D, Liberati A, Tetzlaff J. et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg 2010; 8: 336-41
    CrossrefPubMedGoogle Scholar
  • 8 Pelissier P, Gardet H, Pinsolle V. et al. The keystone design perforator island flap. Part II: clinical applications. J Plast Reconstr Aesthet Surg 2007; 60: 888-91
    CrossrefPubMedGoogle Scholar
  • 9 Stone JP, Webb C, McKinnon JG. et al. Avoiding skin grafts: the keystone flap in cutaneous defects. Plast Reconstr Surg 2015; 136: 404-8
    CrossrefPubMedGoogle Scholar
  • 10 Park HS, Morrison E, Lo C. et al. An application of keystone perforator island flap for closure of lumbosacral myelomeningocele defects. Ann Plast Surg 2016; 77: 332-6
    CrossrefPubMedGoogle Scholar
  • 11 Mohan AT, Rammos CK, Akhavan AA. et al. Evolving concepts of keystone perforator island flaps (KPIF): principles of perforator anatomy, design modifications, and extended clinical applications. Plast Reconstr Surg 2016; 137: 1909-20
    CrossrefPubMedGoogle Scholar
  • 12 Lanni MA, Van Kouwenberg E, Yan A. et al. Applying the keystone design perforator island flap concept in a variety of anatomic locations: a review of 60 consecutive cases by a single surgeon. Ann Plast Surg 2017; 79: 60-7
    CrossrefPubMedGoogle Scholar
  • 13 Park TH, Lee JW, Kim CW. The fortune cookie flap for aesthetic reconstruction after chest keloid resection: a small case series. J Cardiothorac Surg 2018; 13: 31
    CrossrefPubMedGoogle Scholar
  • 14 Behr B, Wagner JM, Wallner C. et al. Reconstructive options for oncologic posterior trunk defects: a review. Front Oncol 2016; 6: 51
    PubMedGoogle Scholar
  • 15 Hamdi M, Stillaert FB. Pedicled perforator flaps in the trunk. Clin Plast Surg 2010; 37: 655-65
    CrossrefPubMedGoogle Scholar
  • 16 Kroll SS, Rosenfield L. Perforator-based flaps for low posterior midline defects. Plast Reconstr Surg 1988; 81: 561-6
    CrossrefPubMedGoogle Scholar
  • 17 Correia B, Costa J, Casanov J. et al. The keystone perforator island flap and its use in complex defects of the trunk: a case report. Rev Port Cir Cardiotorac Vasc 2017; 24: 77-9
    PubMedGoogle Scholar
  • 18 Lazzeri D, Huemer GM, Nicoli F. et al. Indications, outcomes, and complications of pedicled propeller perforator flaps for upper body defects: a systematic review. Arch Plast Surg 2013; 40: 44-50
    Article in Thieme ConnectPubMedGoogle Scholar
  • 19 Bui DT, Cordeiro PG, Hu QY. et al. Free flap reexploration: indications, treatment, and outcomes in 1193 free flaps. Plast Reconstr Surg 2007; 119: 2092-100
    CrossrefPubMedGoogle Scholar
  • 20 Chang EI. My first 100 consecutive microvascular free flaps: pearls and lessons learned in first year of practice. Plast Reconstr Surg Glob Open 2013; 1: e27
    CrossrefPubMedGoogle Scholar
  • 21 Pignatti M, Pasqualini M, Governa M. et al. Propeller flaps for leg reconstruction. J Plast Reconstr Aesthet Surg 2008; 61: 777-83
    CrossrefPubMedGoogle Scholar
  • 22 Bravo FG, Schwarze HP. Free-style local perforator flaps: concept and classification system. J Plast Reconstr Aesthet Surg 2009; 62: 602-9
    CrossrefPubMedGoogle Scholar
  • 23 Hong JP. The use of supermicrosurgery in lower extremity reconstruction: the next step in evolution. Plast Reconstr Surg 2009; 123: 230-5
    CrossrefPubMedGoogle Scholar
  • 24 Kneser U, Beier JP, Schmitz M. et al. Zonal perfusion patterns in pedicled free-style perforator flaps. J Plast Reconstr Aesthet Surg 2014; 67: e9-17
    CrossrefPubMedGoogle Scholar
  • 25 Pignatti M, Ogawa R, Hallock GG. et al. The “Tokyo” consensus on propeller flaps. Plast Reconstr Surg 2011; 127: 716-22
    CrossrefPubMedGoogle Scholar
  • 26 Bekara F, Herlin C, Mojallal A. et al. A systematic review and meta-analysis of perforator-pedicled propeller flaps in lower extremity defects: identification of risk factors for complications. Plast Reconstr Surg 2016; 137: 314-31
    CrossrefPubMedGoogle Scholar