Pelissier Philippe, Gardet Hélène, Pinsolle Vincent, Santoul Max, Behan Felix C
Service de Chirurgie Plastique, Hôpital Pellegrin-Tondu, 33076 Bordeaux, France.
J Plast Reconstr Aesthet Surg. 2007;60(8):888-91. doi: 10.1016/j.bjps.2007.03.023. Epub 2007 May 9.
This curvilinear- and trapezoidal-shaped flap essentially consists of two conjoined V-Y flaps end to side. The vascular supply is supported by the subcutaneous vascular network and is dependent on fascial and muscular perforators. A review of 15 clinical cases was performed to assess the reliability and versatility of the flap.
Twelve keystone flaps were performed following excision of skin tumours or post-traumatic defects in various locations, from the head and neck region, the trunk and the limbs.
No flap necrosis, even partial, was observed regardless of the site and the type of keystone used. Patients were almost pain free in the postoperative course. The aesthetic results are quite satisfactory, as the flap is aligned locally without evidence of the 'pincushioning' appearance sometimes seen around island reconstructions.
Elevation of the flap seems to evenly distribute the tensional forces without undermining. The flap is particularly useful in the repair of defects following skin cancer removal. Bulk is not a problem and good skin cover is achieved.
The presence of perforators and subcutaneous network distributed throughout the body create an environment which makes this flap universally applicable and extremely reliable.
这种曲线形和梯形皮瓣本质上由两个端对侧相连的V-Y皮瓣组成。其血供由皮下血管网支持，并依赖于筋膜和肌肉穿支。对15例临床病例进行了回顾，以评估该皮瓣的可靠性和通用性。
在头颈部、躯干和四肢的不同部位切除皮肤肿瘤或创伤后缺损后，进行了12例关键皮瓣手术。
无论使用的关键皮瓣部位和类型如何，均未观察到皮瓣坏死，甚至部分坏死也未出现。患者术后过程几乎无疼痛。美学效果相当令人满意，因为皮瓣在局部对齐，没有出现有时在岛状重建周围看到的“针垫样”外观。
皮瓣的掀起似乎能均匀分布张力而不进行潜行分离。该皮瓣在修复皮肤癌切除后的缺损方面特别有用。体积不是问题，能实现良好的皮肤覆盖。
遍布全身的穿支和皮下网络的存在创造了一个环境，使得该皮瓣普遍适用且极其可靠。
