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Keystone flaps

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keystone flaps are an excellent option that can be used to reconstruct different types of defects mainly in the extremities.

Publicado en: Salud y medicina
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Keystone flaps

  1. 1. Keystone Flaps By: Mohamed Amin Plastic Surgery Department-Shebin Elkom Teaching Hospital
  2. 2. Keystone flaps Design Principles  Variations
  3. 3.  The keystone flap was invented by Felix Behan as early as 1995, but was first described by him in 2003  it was named based on its similarity to the keystone of Roman archways  The keystone flap is unique among locoregional flaps because it demonstrates a high capacity for adaptation  It’s old name is Arc flap or Island flap.
  4. 4. keystone of Roman archways
  5. 5. Classification: A-Degree of Islanding B-Type of Mobilization
  6. 6. Islanding is the process of circumferential division of a given piece of tissue Islanding can refer to skin,fascia or both Islanding of the skin provides a potential benefit to cutaneous perfusion (5% increase) A-Degree of Islanding
  7. 7. B-Type of Mobilization  The typical mobilization is by advancement with V-Y closure at the two vertices of the larger arc  However, one end, or both ends, may be transposed and their shape adapted to permit rotation as required by the region  Double keystone flap closure may be by direct symmetrical apposition or by opposing transposition/advancement .  Skin grafting of the secondary defect may be undertaken if direct closure is likely to be too tight
  8. 8. Standard design of the keystone flap 1:1 ratio of defect width to flap width
  9. 9. Double opposing Keystone Flap design
  10. 10. Principles of keystone flap design Design is perpendicular to the long axis of the limb 1:1 width ratio or larger Divide fascia along long arc of flap - >islanding fascia Utilize creep /temporary mattress sutures/permanent continuous sutures
  11. 11. Design is perpendicular to the long axis of the limb Why?
  12. 12. due to the underlying longitudinal septal supply to the skin
  13. 13. 1:1 width ratio or larger Pinch test
  14. 14. Divide fascia along long arc of flap ->islanding fascia Subcutaneous level Fascial level (multiple windows)
  15. 15. Utilize creep  Creep is defined as the capacity for a material (e.g., skin) to elongate when placed under constant tension  the skin elongates along the axis of the tension through both biological and mechanical creep Temporary sutures across widest point of defect
  16. 16. permanent continuous sutures Continous sutures to distribute tension along entire flap
  17. 17. Quiz 1
  18. 18. Quiz2
  19. 19. Quiz3 Venous malformation
  20. 20. Quiz4
  21. 21. Thank you