Improving the reliability of the Keystone flap

Improving the reliability of the Keystone flap Eur J Plast Surg (2016) 39:237–238 DOI 10.1007/s00238-015-1097-y LETTER TO THE EDITOR 1 1 1 1 Dariush Nikkhah & Roshan Vijayan & Ian King & Duncan Bayne Received: 8 February 2015 /Accepted: 14 April 2015 /Published online: 6 May 2015 Springer-Verlag Berlin Heidelberg 2015 Sir, We have found that at least doubling the flap to defect ratio The defects after lower limb skin cancer excision espe- has eliminated any need for back grafting and allowed direct cially in the elderly patient cannot often close directly closure on limbs with friable inelastic skin (Fig. 1). This is due to unfavourable tissue factors such as poor skin quicker than converting a type I or type IIa flap to the type III quality, inelastic skin, and peripheral oedema. Tradition- variant and allows for a much more robust flap. ally, skin grafting is performed with variable success; Behan’s suture protocol using a few interrupted non- failure occurs for many reasons including graft shear, resorbable mattress tensioning sutures and a continuous run- haematoma, wound oedema, and infection [1]. Post-op- ning non-resorbable horizontal mattress suture to hem the eratively, a successful graft and donor site require reg- wound works well but requires staged removal of European Journal of Plastic Surgery Springer Journals

Improving the reliability of the Keystone flap

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Springer Berlin Heidelberg
Copyright © 2016 by Springer-Verlag Berlin Heidelberg
Medicine & Public Health; Plastic Surgery
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