Schepler Hadrian, Sauerbier Michael, Grabbe Stephan, Rietz Stephan
Universitätsmedizin Mainz Hautklinik.
Berufsgenossenschaftliche Unfallklinik Frankfurt am Main Abteilung für Plastische, Hand- und Rekonstruktive Chirurgie.
Handchir Mikrochir Plast Chir. 2019 Aug;51(4):232-237. doi: 10.1055/a-0839-4974. Epub 2019 Apr 8.
Since the KDPFC was first described by Behan et al. in 2003, there have been a number of publications about this technique with case series between 1 and 300 flaps, and some have described further modifications of the design of the flap. The flap design resembles the keystone of a Roman arch and is based on the angiosome concept. The flap is a perforator flap, but does not require microsurgical dissection or preparation of the perforators. The technique is efficient and relatively simple to perform. With a few exceptions, it can be performed anywhere on the body. Although there are a large number of publications, not much data has been published on the complications, limitations and disadvantages of the technique.
This is a retrospective analysis of the outcomes of 35 patients who underwent keystone flap reconstruction for soft tissue defects over 36 months. The flap design followed the original KDPFC description. Flap selection was based on the requirements of each defect.
Thirty-six flap procedures were performed on 35 patients. The mean defect size was 21 cm (range 2-100 cm). Delayed wound healing occurred in 12 patients and flap loss was observed in 4 patients. One patient required further surgical revision. The wounds of the remaining patients healed by secondary intention. Four out of 10 patients who were on anticoagulants had delayed wound healing, compared with 12 out of 25 who were not on anticoagulants. Seven of the 16 patients with delayed wound healing, including 3 patients with flap loss, had defects reconstructed on the very distal lower leg and foot.
The KDPFC is a valuable addition to the reconstructive armamentarium. Although delayed wound healing has been observed in some cases, this flap concept can replace other local or regional flaps, also in more complex situations. Care must be taken in patient selection and, in particular, in large defects and difficult topographical areas on the distal lower leg. In these situations, other reconstructive options may be more appropriate.
自2003年贝汉等人首次描述关键型穿支筋膜皮瓣（KDPFC）以来，已有多篇关于该技术的文献发表，病例系列报道的皮瓣数量在1至300例之间，一些文献还描述了皮瓣设计的进一步改进。该皮瓣设计类似于罗马拱门的拱心石，基于血管体概念。该皮瓣是穿支皮瓣，但不需要对穿支进行显微外科解剖或预处理。该技术操作高效且相对简单。除少数情况外，身体任何部位均可实施。尽管有大量文献发表，但关于该技术的并发症、局限性和缺点的数据报道较少。
这是一项对35例患者在36个月内接受关键型皮瓣重建软组织缺损手术结果的回顾性分析。皮瓣设计遵循最初对KDPFC的描述。皮瓣选择基于每个缺损的需求。
对35例患者实施了36次皮瓣手术。平均缺损大小为21厘米（范围2至100厘米）。12例患者出现伤口愈合延迟，4例患者观察到皮瓣坏死。1例患者需要进一步手术修复。其余患者的伤口通过二期愈合。10例服用抗凝剂的患者中有4例伤口愈合延迟，而25例未服用抗凝剂的患者中有12例出现此情况。16例伤口愈合延迟的患者中有7例，包括3例皮瓣坏死患者，其缺损位于小腿远端和足部。
KDPFC是重建手段中的一项有价值的补充。尽管在某些情况下观察到伤口愈合延迟，但该皮瓣概念在更复杂的情况下也可替代其他局部或区域皮瓣。在患者选择时必须谨慎，尤其是对于大的缺损以及小腿远端复杂的地形区域。在这些情况下，其他重建选择可能更合适。
