AUTHOR=Jovic Thomas H. , Jessop Zita M. , Slade Robert , Dobbs Thomas , Whitaker Iain S. 

TITLE=The Use of Keystone Flaps in Periarticular Wound Closure: A Case Series

JOURNAL=Frontiers in Surgery

VOLUME=Volume 4 - 2017

YEAR=2017

URL=https://www.frontiersin.org/journals/surgery/articles/10.3389/fsurg.2017.00068

DOI=10.3389/fsurg.2017.00068

ISSN=2296-875X

ABSTRACT=The Keystone perforator island flap (Keystone flap), is a Type A fasciocutaneous advancement flap, consisting of two V to Y advancement flaps.
Skin cancer excision around joints presents a number of reconstructive challenges. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and withstand regional changes in tensile pressures. 

We report a single-surgeon series of 5 cases of periarticular keystone flap between 2014 and 2017. Data was collected from operation notes, clinical photography, histopathology and outpatient clinic records. The indication for keystone flap was skin cancer in all cases (n=5). The largest defect size post-excision in was 75x40x15mm. All keystone flaps demonstrate a colour and cosmetic appearance comparable to adjacent tissue. There were no major post-operative complications including flap failure or impaired range of joint movement in the follow up period. Superficial wound infection occurred post-operatively in one case. This is the first case series to discuss the use of keystone flaps in periarticular wound closure. Locoregional fasciocutaneous wound coverage offered by keystone flaps may alleviate the risks of graft failure, contour defects and donor site morbidity associated with alternative reconstructive options, with good functional and cosmetic outcomes. We advocate their use as a robust reconstructive option in periarticular areas.