title: Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects.
abstract: BACKGROUND
  Radical inguinal lymphadenectomy (RIL) for bulky metastatic melanoma and non-melanoma skin cancers of the inguinal region, while shown to improve morbidity and survival oncologically, can result in substantial morbidity from wound complications. Skin defects cannot be closed primarily and the substantial dead space predisposes to seroma, wound dehiscence and infection. Despite the clear need for reconstructive options, extended series describing reconstruction of large inguinal defects in this setting have not been reported.
  
  
  METHODS
  A prospectively entered, retrospectively reviewed study of 20 consecutive patients undergoing quadriceps keystone island flaps (QKIF) for the closure of complicated inguinal defects is described.
  
  
  RESULTS
  There was 100% flap survival, with no partial or complete flap losses. A reduction in wound breakdown/dehiscence from reported rates was seen, with four patients (20%) having wound breakdown, compared to double that rate in reported series. Other wound complications comprised six patients (30%) with mild wound infections, seven patients (35%) with seromas and two patients (10%) with haematomas.
  
  
  CONCLUSIONS
  The QKIF is an effective means of reconstructing inguinal defects after RIL, particularly in high-risk patients, and is technically simpler than other reconstructive techniques advocated for this purpose. Furthermore, the QKIF offers patients with advanced disease (where management is primarily palliative) a potentially improved quality of life with reduced operative morbidity.
authors.affiliation: Department of Surgical Oncology, Peter MacCallum Cancer Centre, East Melbourne, Victoria, Australia.
authors.forename: Felix C
authors.initials: FC
authors.lastname: Behan
authors.forename: Alenka
authors.initials: A
authors.lastname: Paddle
authors.forename: Warren M
authors.initials: WM
authors.lastname: Rozen
authors.forename: Xuan
authors.initials: X
authors.lastname: Ye
authors.forename: David
authors.initials: D
authors.lastname: Speakman
authors.forename: Michael W
authors.initials: MW
authors.lastname: Findlay
authors.forename: Michael A
authors.initials: MA
authors.lastname: Henderson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D005260:Female; D006119:Groin / Q000601:surgery*; D006801:Humans; D007902:Length of Stay; D008197:Lymph Node Excision / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008545:Melanoma / Q000453:epidemiology / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D019651:Plastic Surgery Procedures / Q000379:methods*; D012878:Skin Neoplasms / Q000453:epidemiology / Q000601:surgery*; D013524:Surgical Flaps