Keystone Flap for Coverage of Large Thoracic Defects: Case Report
DOI:
https://doi.org/10.20453/rmh.v36i2.5053Keywords:
Keystone flap, Thoracic cavity, Plastic surgeryAbstract
The Keystone island flap is a reconstructive surgical technique used to close large defects in the head, limbs, and trunk. It allows the use of adjacent skin with an excellent color match, reduces operative time, and avoids more complex procedures such as free flaps or grafts. This article describes the use of the Keystone flap in chest wall reconstruction, emphasizing its versatility due to multiple musculocutaneous perforators. It aims to provide plastic surgeons with confidence and flexibility in covering large thoracic soft tissue defects, thereby achieving safe and aesthetically acceptable results. Recommendations and lessons on its use are provided, demonstrating its adaptability to various defect types, ranging from oncological to traumatic lesions, and reducing postoperative mortality while promoting faster recovery.
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Rodriguez-Unda NA, Abraham JT, Saint-Cyr M. Keystone and Perforator Flaps in Reconstruction: Modifications and Updated Applications. Clin Plast Surg. 2020 Oct;47(4):635-648. doi: 10.1016/j.cps.2020.06.014
Ettinger KS, Fernandes RP, Arce K. Keystone Flap. Atlas Oral Maxillofac Surg Clin North Am. 2020 Mar;28(1):29-42. doi: 10.1016/j.cxom.2019.10.001
Gómez O, Barón OI, Peñarredonda ML, Flórez SA. Colgajos tipo Keystone: cobertura estable con ahorro cutáneo. Rev Colomb Cir Plást Reconstr. 2018;24(2018):1–15. Disponibe en: http://ciplastica.com/ojs/index.php/rccp/article/view/65
Srivastav S, Gupta S, Sharma A. Keystone Flap as a Reconstructive Option for selected areas; A Prospective Study. J Clin Orthop Trauma. 2020 Oct;11(Suppl 5): S871-S875. doi: 10.1016/j.jcot.2020.06.019
Salazar RE, Girón KA. Colgajo “Keystone” (Colgajo en Piedra Angular) para Reconstrucción de Defectos Amplios en tórax posterior. Reporte de Caso. Rev Guatem Cir. 2021; 27:54–61. Disponible en: https://pp.centramerica.com/pp/bancofotos/1519-40796.pdf
Crisan D, Schneider LA, Coneac A. Miniaturizing the keystone flap: An alternative to helical crus reconstruction after tumor surgery. J Am Acad Dermatol. 2021;85(2): e75–7. doi: 10.1016/j.jaad.2018.08.025
Aragón-Miguel R, Gutiérrez-Pascual M, Sánchez-Gilo A, Sanz-Bueno J, Vicente-Martin FJ. Aplicación del colgajo de keystone en dermatología. Experiencia clínica en 18 pacientes. Actas Dermosifiliogr. 2018;109(6):515–20. doi: 10.1016/j.ad.2018.02.012
Lo Torto F, Frattaroli JM, Kaciulyte J, Mori FLR, Troisi L, Ciudad P, et al. The keystone flap: A multi-centric experience in elderly patients treatment. J Plast Reconstr Aesthet Surg. 2022;75(1):226–39. doi: 10.1016/j.bjps.2021.08.043
Molitor M, Simek M, Lonský V, Kaláb M, Veselý J, Zálešák B. Pectoral muscle flap with V-Y skin paddle for covering sternal defects. Ann Thorac Surg. 2012 Nov;94(5):e131-3. doi: 10.1016/j.athoracsur.2012.08.017
Rochester SN, Lorenz W, Bolton W, Stephenson J, Ben-Or S. Pectoralis Muscle Flaps for Mediastinal Reconstruction. Oper Tech Thorac Cardiovasc Surg. 2020;25(1):42–56. doi: 10.1053/j.optechstcvs.2019.11.004
Dolan RT, Moosa A, Giele HP. The Adipofascial Deltopectoral Flap to Cover the Brachial Plexus in Thoracic Outlet Syndrome and Radiation Plexitis. J Plast Reconstr Aesthet Surg. 2020 Aug;73(8):1465-1472. doi: 10.1016/j.bjps.2020.02.039
Teo KG, Rozen WM, Acosta R. The pectoralis major myocutaneous flap. J Reconstr Microsurg. 2013 Sep;29(7):449-56. doi: 10.1055/s-0033-1343832
Al-Mufarrej F, Martinez-Jorge J, Carlsen BT, Saint-Cyr M, Moran SL, Mardini S. Use of the deltoid branch-based clavicular head of pectoralis major muscle flap in isolated sternoclavicular infections. J Plast Reconstr Aesthet Surg. 2013 Dec;66(12):1702-11. doi: 10.1016/j.bjps.2013.06.057
Lamp S, Lester JL. Reconstruction of the breast following mastectomy. Semin Oncol Nurs. 2015 May;31(2):134-45. doi: 10.1016/j.soncn.2015.02.009
Alves HRN, de Faria JCM, Dos Santos RV, Cernea C, Busnardo F, Gemperli R. Supraclavicular flap as a salvage procedure in reconstruction of head and neck complex defects. J Plast Reconstr Aesthet Surg. 2019 Apr;72(4):e9-e14. doi: 10.1016/j.bjps.2018.12.050
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Copyright (c) 2025 William Diaz Chaker, Diego Sanchez Martinez, Jose Saenz Lopez, Daniel Diaz Coronel, Julian Padilla Rojas
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