title: Avoiding Skin Grafts: The Keystone Flap in Cutaneous Defects.
abstract: The Keystone Design Perforator Island Flap is a fasciocutaneous perforator flap resembling two end-to-end VY flaps. We used a modification of the original design to avoid extending the incision into an elliptical pattern, and maintained a trailing skin bridge whilst incising fascia in a tunneling fashion. Thirty patients underwent 32 flaps mainly on the lower leg to close defects that would traditionally require skin grafting. All flaps survived completely, with minor complications in four patients. All but five patients were allowed unrestricted ambulation after surgery. The modified design is straightforward to learn, has reliable perfusion, and provides a simpler recovery for patients.
  
  
  METHODS
  Therapeutic, IV.
authors.affiliation: Calgary, Alberta, Canada From the Divisions of Plastic Surgery and Surgical Oncology, Department of Surgery, and the Tom Baker Cancer Centre, University of Calgary.
authors.forename: Jill P
authors.initials: JP
authors.lastname: Stone
authors.forename: Carmen
authors.initials: C
authors.lastname: Webb
authors.forename: J Gregory
authors.initials: JG
authors.lastname: McKinnon
authors.forename: Jeffrey C
authors.initials: JC
authors.lastname: Dawes
authors.forename: C David
authors.initials: CD
authors.lastname: McKenzie
authors.forename: Claire F
authors.initials: CF
authors.lastname: Temple-Oberle
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D058752:Free Tissue Flaps / Q000098:blood supply* / Q000637:transplantation; D006084:Graft Rejection; D006085:Graft Survival; D006801:Humans; D035002:Lower Extremity; D008297:Male; D008545:Melanoma / Q000473:pathology / Q000601:surgery*; D008875:Middle Aged; D064827:Myocutaneous Flap / Q000098:blood supply* / Q000637:transplantation; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*; D016038:Skin Transplantation; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult