Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, South Korea.
J Craniofac Surg. 2021;32(5):1813-1816. doi: 10.1097/SCS.0000000000007581.
The coverage of the posterior neck and lower occipital scalp defects should be approached carefully. Thick, stiff, and inelastic skin properties of these areas tend to make coverage of even small defects difficult. Herein, the authors present a retrospective review of our experience with posterior neck and lower occipital scalp reconstruction using the keystone flap (KF) and describe the expanding versatility of KF reconstruction. The medical records of 17 patients who underwent KF reconstruction to cover the posterior neck and lower occipital defect from April 2017 to May 2020 were reviewed. Clinical and operative data were collected. All defects were successfully covered with the KFs. The defect sizes ranged from 2.5 × 3.5 cm to 6 × 11 cm, and the flap sizes ranged from 3 × 5.5 cm to 9 × 18 cm. All flaps fully survived, although marginal maceration developed in one case; however, it healed with conservative management. The final results were favorable, and all patients were satisfied with their final outcomes. Consequently, the KF can be considered as a good reconstruction modality with few complications and provides an alternative to other reconstructive options for coverage of the posterior neck and lower occipital defects.
颈后和枕下部头皮缺损的覆盖应谨慎处理。这些部位的皮肤厚、硬且无弹性，即使是小的缺损，覆盖起来也很困难。本文回顾性分析了作者采用关键成形皮瓣（keystone flap，KF）修复颈后和枕下部头皮缺损的经验，并描述了 KF 修复的扩展应用。回顾了 2017 年 4 月至 2020 年 5 月期间 17 例采用 KF 修复颈后和枕下部缺损的患者的临床资料，收集了临床和手术数据。所有 KF 均成功覆盖了颈后和枕下部的缺损。缺损大小为 2.5×3.5cm 至 6×11cm，皮瓣大小为 3×5.5cm 至 9×18cm。所有皮瓣均完全存活，虽然一例出现边缘浸渍，但经保守治疗后愈合。最终结果良好，所有患者对最终结果均满意。因此，KF 可作为一种并发症少的良好重建方式，为颈后和枕下部缺损的覆盖提供了另一种选择。
