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      • Record: found
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      New Keystone flap application in vulvo-perineal reconstructive surgery: A case series

      case-report

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          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Highlights

          • •

            Keystone design perforator island flap (KPIF) has been developed by Behan in 1995.

          • •

            KPIF seems to be a new innovative and useful solution after a wide vulvar excision.

          • •

            We found that Key Stone technique is an extremely simple and effective solution.

          • •

            KPIF seems to be associated minimal morbidity.

          • •

            KPIF showed less risk of flaps necrosis and lower complications.

          Abstract

          Objective

          This study aimed to evaluate the application of the Keystone flap technique and the long-term results of vulvovaginal reconstruction after vulvar surgery .

          Methods

          This is the first case series describing the application of the Keystone perforator island flaps (KPIF) technique to close a wide defect after radical vulvectomy. We prospectively collected patient demographics, operative times, complications, pathologic results, and length of stay on all patients. The benefits, cosmetic results and satisfaction of patients were analyzed in the follow up.

          Results

          Five patients were selected for the study: four underwent radical vulvectomy for squamous cell vulvar cancer, and one underwent vulvar wide excision for Paget disease followed by reconstruction with the Keystone flap technique. The defects were successfully covered by the Keystone flap technique in all patients.

          Conclusions

          Keystone flaps seem to be easy to design and elevate, and it offers rapid fasciocutaneous closure in wide vulvo-perineal defects with excellent long-term results.

          Related collections

          Most cited references15

          • Record: found
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          The Keystone Design Perforator Island Flap in reconstructive surgery.

          Shawn Behan (2003)
          A surgical technique for closing skin defects following skin cancer (particularly melanoma) removal is described in the present paper. Its use is illustrated in five patients. The technique has been used in 300 cases over the past 7 years and is suitable for all areas of the body from scalp to foot. We have coined the term Keystone Design Perforator Island Flap (KDPIF) because of its curvilinear shaped trapezoidal design borrowed from architectural terminology. It is essentially elliptical in shape with its long axis adjacent to the long axis of the defect. The flap is based on randomly located vascular perforators. The wound is closed directly, the mid-line area is the line of maximum tension and by V-Y advancement of each end of the flap, the 'islanded' flap fills the defect. This allows the secondary defect on the opposite side to be closed, exploiting the mobility of the adjacent surrounding tissue. The importance of blunt dissection is emphasized in raising these perforator island flaps as it preserves the vascular integrity of the musculocutaneous and fasciocutaneous perforators together with venous and neural connections. The keystone flap minimizes the need for skin grafting in the majority of cases and produces excellent aesthetic results. Four types of flaps are described: Type I (direct closure), Type II (with or without grafting), Type III (employs a double island flap technique), and Type IV (involves rotation and advancement with or without grafting). The patient is almost pain free in the postoperative phase. Early mobilization is possible, allowing this technique to be used in short stay patients. In a series of 300 patients with flaps situated over the extremities, trunk and facial region, primary wound healing was achieved in 99.6% with one out of 300 developing partial necrosis of the flap. The technique described in the present article offers a simple and effective method of wound closure in situations that would otherwise have required complex flap closure or skin grafting particularly for melanoma.
          Article 0 comments Cited 69 times – based on 0 reviews     Review now
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            • Record: found
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            Vaginal reconstruction with gracilis myocutaneous flaps.

            Gene M. Massey, Jonathan Horton, F McCraw … (1976)
            The definition, history, experimental background, surgical technique, and clinical applications of compound gracilis myocutaneous flaps are presented. This flap has been our method of choice for neo-vaginal reconstruction after radical pelvic surgery.
            Article 0 comments Cited 27 times – based on 0 reviews     Review now
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              Risk factors for impaired healing of the perineal wound after abdominoperineal resection of rectum for carcinoma.

              Derek Smith, D Artioukh, Jarishma K. Gokul (2007)
              Nonhealing perineal wound is an unpleasant complication of surgical excision of the rectum and anus. The aim of the study was to evaluate the risk factors for impaired perineal wound healing after abdominoperineal resection (APR) of rectum for adenocarcinoma, particularly with the increasing use of neo-adjuvant chemoradiation. The study included 38 consecutive patients (29 men, nine women; median age 66 years, range: 43-86), who underwent surgical excision of rectum and anus for adenocarcinoma from 1999 to 2004. Thirty-seven patients underwent APR of rectum and one patient, who developed carcinoma in the background of chronic ulcerative colitis, had panproctocolectomy. Associations between the failure of the perineal wound to heal and a number of patient, tumour and treatment-related variables were evaluated by Pearson chi-square test or Fisher's exact test, as appropriate. A P-value of <0.05 was considered significant. Multivariate statistical technique of principal component analysis was also used to identify risk factors and their relative contribution to impaired healing. Impaired healing of the perineal wound was observed in 10 (26%) of 38 patients. In four of them (11%) the wound remained nonhealed in 1 year after surgery. Preoperative radiotherapy, delayed primary closure of the wound and alcohol consumption in excess of 28 units/week was statistically significantly associated with impaired wound healing. Principal component analysis identified the following seven factors that cumulatively contributed to 96% of impaired healing: (i) distant metastases, (ii) preoperative radiotherapy, (iii) T-stage of the tumour, (iv) smoking, (v) perioperative blood transfusion, (vi) preoperative chemotherapy and (vii) development of side effects of preoperative chemoradiation. Patients who undergo APR of rectum are prone to impaired healing of the perineal wound if radiotherapy is used to treat malignancy prior to surgery and wound closure is delayed. In addition, the wound may not heal in patients with distant metastases, excessive alcohol consumption, present and past smokers and those who suffer adverse effects of preoperative chemoradiation and require blood transfusion.
              Article 0 comments Cited 27 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Michele Peiretti
                Journal
                Journal ID (nlm-ta): Gynecol Oncol Rep
                Journal ID (iso-abbrev): Gynecol Oncol Rep
                Title: Gynecologic Oncology Reports
                Publisher: Elsevier
                ISSN (Electronic): 2352-5789
                Publication date PMC-release: 18 October 2019
                Publication date Collection: November 2019
                Publication date (Electronic): 18 October 2019
                Volume: 30
                Electronic Location Identifier: 100505
                Affiliations
                [a ]Department of Surgical Sciences, Division of Gynecology and Obstetrics, University of Cagliari, Italy
                [b ]Department of Surgical Sciences, Plastic Surgery and Microsurgery Unit, University of Cagliari, Italy
                Author notes
                [* ]Corresponding author at: Division of Gynecology and Obstetrics, University of Cagliari, SS554, Blocco Q, Policlinico Universitario, C.A.P. 09042 Monserrato, CA, Italy. michelepeiretti@ 123456hotmail.com
                Article
                Publisher ID: S2352-5789(19)30094-3 Publisher ID: 100505
                DOI: 10.1016/j.gore.2019.100505
                PMC ID: 6819813
                PubMed ID: 31687469
                SO-VID: 86a7f44a-e270-47cc-b952-ba9f95d967af
                Copyright © © 2019 Published by Elsevier Inc.
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 28 May 2019
                Date revision received : 8 September 2019
                Date accepted : 23 September 2019
                Categories
                Subject: Case Series

                Keywords: vulvar cancer,key stone flap,reconstructive surgery
                Data availability:
                Keywords: vulvar cancer, key stone flap, reconstructive surgery

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