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The Modified Keystone Flap for Pressure Ulcers

A Modification of the Keystone Flap With Rotation and Advancement

Byun, Il Hwan, MD*; Kim, Chan Woo, MD; Park, Tae Hwan, MD, PhD

doi: 10.1097/SAP.0000000000001677
Reconstructive Surgery

Introduction The reconstruction of extensive soft tissue defects from pressure ulcers is a great challenge. Resurfacing such defects with like tissues and minimizing morbidities are important. Here we present our surgical experience using a novel modified keystone flap for pressure ulcer patients.

Methods We retrospectively reviewed the data of 13 consecutive cases reconstructed with the modified keystone flaps between March and December, 2017. The mean dimensions of the reconstructed defect were 7.7 × 6.5 cm, while the mean dimensions of the flap were 12.1 × 8.3 cm.

Results Time efficient reconstructions with the modified keystone flap were performed without any following major complications. Minor wound dehiscence occurred in only one case, which soon healed with conservative management.

Conclusions Considering its simple design, reliable flap survival, minimal donor-site morbidity, optimal flap thickness, and evenly distributed surgical tension, our novel technique of the modified keystone flap is as an excellent surgical option for the reconstruction of pressure ulcers in the gluteal region.

From the *Department of Plastic & Reconstructive Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea; and

Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea.

Received April 20, 2018, and accepted for publication, after revision August 28, 2018.

Conflicts of interest and sources of funding: This work was supported by the National Research Foundation of Korea (NRF) grant funded by the Korea government (MSIP; Ministry of Science, ICT & Future Planning) (No. 2017R1C1B5017180, TH Park) and was also supported by a grant of the Research Driven Hospital R & D Project, funded by CHA Bundang Medical Center (No. BDCHA R&D 2017-013, TH Park). The authors declare no conflict of interest.

Financial Disclosures: None.

Ethical Approval: This study was approved by the institutional review board of the CHA University (2017-09-027-002) and conducted in accordance with the Declaration of Helsinki.

Reprints: Tae Hwan Park, MD, PhD, Department of Plastic and Reconstructive Surgery, CHA University College of Medicine, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi 13496, Korea. E-mail:

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