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Abstract：
OBJECTIVE: A very few flaps would be described as versatile as the Keystone Flap. There is an increasing demand for coverage of defects in lower limb due to traumatic defects as well as other parts of the body. Keystone flap is one of its kind, which is simple and easy to perform. It is a safe option for conditions where microsurgery may not be a viable option. The relative simplicity of this flap makes it a to go option at many places.
METHODS: A prospective study was developed from October 2017 to December 2019 at SMS Hospital, Jaipur. We assessed the size of the flap, operation time, average hospital stay and the complications. Perforators over the leg were Doppler marked preoperatively over which the flap was raised.
RESULTS: 50 patients were taken into the study. 30 key stone flaps were done to cover lower limb defects, 10 flaps were done for upper limb defects and the remaining 10 were for trunk defects. The average intraoperative time from skin incision to final suture was 50 min (range 20-90 min). The largest defect covered by keystone flap in our series measured 50 × 20 cm and the smallest defect covered was 8 × 4 cm. The average hospital stay was 3 days. We observed partial flap necrosis in 2 cases which required skin grafting. 3 other cases had wound infection leading to wound dehiscence, which required secondary suturing. The overall success rate was 95%.
CONCLUSIONS: The Keystone flap being a versatile flap with its qualities of replacing \"like with like\", easy to perform, use of local tissue, good vascularity and a low complication rate makes it an excellent flap for a variety of defects. The KeyStone flap allows reconstruction in a single stage and is a relatively easy and fast technique for the beginner as well as the experienced surgeon. We believe it should be incorporated more into a surgeons practice.
METHODS: A prospective study was developed from October 2017 to December 2019 at SMS Hospital, Jaipur. We assessed the size of the flap, operation time, average hospital stay and the complications. Perforators over the leg were Doppler marked preoperatively over which the flap was raised.
RESULTS: 50 patients were taken into the study. 30 key stone flaps were done to cover lower limb defects, 10 flaps were done for upper limb defects and the remaining 10 were for trunk defects. The average intraoperative time from skin incision to final suture was 50 min (range 20-90 min). The largest defect covered by keystone flap in our series measured 50 × 20 cm and the smallest defect covered was 8 × 4 cm. The average hospital stay was 3 days. We observed partial flap necrosis in 2 cases which required skin grafting. 3 other cases had wound infection leading to wound dehiscence, which required secondary suturing. The overall success rate was 95%.
CONCLUSIONS: The Keystone flap being a versatile flap with its qualities of replacing \"like with like\", easy to perform, use of local tissue, good vascularity and a low complication rate makes it an excellent flap for a variety of defects. The KeyStone flap allows reconstruction in a single stage and is a relatively easy and fast technique for the beginner as well as the experienced surgeon. We believe it should be incorporated more into a surgeons practice.
摘要：
目的：极少数皮瓣可以描述为与Keystone皮瓣一样通用。由于创伤性缺陷以及身体的其他部位,对覆盖下肢缺陷的需求日益增加。Keystone皮瓣是其中一种，这是简单和易于执行。对于显微外科手术可能不是可行选择的情况，这是一个安全的选择。这种皮瓣的相对简单，使其成为许多地方的选择。
方法：一项前瞻性研究于2017年10月至2019年12月在SMS医院进行，斋浦尔.我们评估了皮瓣的大小，操作时间,平均住院时间和并发症。术前，腿上的穿孔器被多普勒标记，皮瓣被抬起。
结果：50名患者被纳入研究。30个关键的结石皮瓣覆盖下肢缺损，10个皮瓣用于上肢缺损，其余10个用于躯干缺损。从皮肤切口到最终缝合的平均术中时间为50分钟（范围为20-90分钟）。在我们的系列中，梯形皮瓣覆盖的最大缺损为50×20cm，覆盖的最小缺损为8×4cm。平均住院时间为3天。我们观察到2例需要植皮的皮瓣部分坏死。其他3例伤口感染导致伤口裂开，这需要二次缝合。总体成功率为95%。
结论：Keystone皮瓣是一种多功能皮瓣，具有代替“喜欢”的特性，易于执行，使用局部组织，良好的血管和低并发症发生率使其成为各种缺陷的优秀皮瓣。KeyStone皮瓣允许在一个阶段重建，是一个相对容易和快速的技术初学者以及经验丰富的外科医生。我们认为应该将其更多地纳入外科医生的实践中。
方法：一项前瞻性研究于2017年10月至2019年12月在SMS医院进行，斋浦尔.我们评估了皮瓣的大小，操作时间,平均住院时间和并发症。术前，腿上的穿孔器被多普勒标记，皮瓣被抬起。
结果：50名患者被纳入研究。30个关键的结石皮瓣覆盖下肢缺损，10个皮瓣用于上肢缺损，其余10个用于躯干缺损。从皮肤切口到最终缝合的平均术中时间为50分钟（范围为20-90分钟）。在我们的系列中，梯形皮瓣覆盖的最大缺损为50×20cm，覆盖的最小缺损为8×4cm。平均住院时间为3天。我们观察到2例需要植皮的皮瓣部分坏死。其他3例伤口感染导致伤口裂开，这需要二次缝合。总体成功率为95%。
结论：Keystone皮瓣是一种多功能皮瓣，具有代替“喜欢”的特性，易于执行，使用局部组织，良好的血管和低并发症发生率使其成为各种缺陷的优秀皮瓣。KeyStone皮瓣允许在一个阶段重建，是一个相对容易和快速的技术初学者以及经验丰富的外科医生。我们认为应该将其更多地纳入外科医生的实践中。
