Behan Felix, Sizeland Andrew, Porcedu Sandro, Somia Naveen, Wilson Jeremy
Department of Surgical Oncology (Melanoma and Head & Neck), Peter MacCallum Cancer Centre (Melbourne) Plastic Surgery Unit, Western Hospital (Melbourne), Australia.
ANZ J Surg. 2006 May;76(5):407-13. doi: 10.1111/j.1445-2197.2006.03708.x.
The Keystone Flap is an island flap that is very useful for repairing skin defects of the integument. Described as a keystone, this arc-shaped flap in fact consists of a schematically designed, perforator-based reconstructive unit which serendipitously resembles two conjoined VY flaps. This facilitates closure because of the multiple VY points at the extremes, where the surrounding tissue is advanced to close the defect while the flap size remains basically static.
A consecutive series of nine cases involving the head and neck and inguinal regions were examined to show the use of the Keystone Flap in irradiated tissue for recurrent disease. They are described by using a combination of clinical illustrations and diagrams to explain the surgical technique.
The average age of the patients in the series is 74 years. A low complication rate and rapid wound healing with no significant flap necrosis was shown in this series. Additionally the short operation time is quite beneficial, particularly for the elderly.
There is a low complication rate using Keystone flaps (this double VY is a clinical development from Diffenbach's original work of 1848(1)) and this technique is particularly useful in achieving wound healing especially after irradiation treatment. This surgical technique once mastered is easy to perform. Another bonus is that there is minimal use of postoperative analgesia. Additional XRT is well tolerated by the patients with minimal evidence of wound complications, while achieving an acceptable aesthetic appearance.
梯形皮瓣是一种岛状皮瓣，对修复体表皮肤缺损非常有用。这种弧形皮瓣被描述为梯形，实际上由一个基于穿支血管、经示意性设计的重建单元组成，巧合的是它类似于两个相连的V-Y皮瓣。由于在两端有多个V-Y点，这便于关闭创口，在这些点处，周围组织向前推进以闭合缺损，而皮瓣大小基本保持不变。
对连续9例涉及头颈部和腹股沟区域的病例进行检查，以展示梯形皮瓣在放射性组织复发性疾病中的应用。通过临床图片和示意图相结合的方式对其进行描述，以解释手术技术。
该系列患者的平均年龄为74岁。该系列显示出低并发症发生率、伤口快速愈合且无明显皮瓣坏死。此外，手术时间短非常有益，尤其是对老年人而言。
使用梯形皮瓣的并发症发生率较低（这种双V-Y皮瓣是1848年迪芬巴赫原始工作的临床发展成果(1)），并且该技术在实现伤口愈合方面特别有用，尤其是在放射治疗后。这种手术技术一旦掌握就很容易实施。另一个好处是术后镇痛药物的使用极少。患者对额外的放疗耐受性良好，伤口并发症迹象最少，同时能达到可接受的美观效果。
