The Keystone Flap: Not an Advance, Just a Stretch
Background The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V–Y advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. It...
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Published in | Annals of surgical oncology Vol. 20; no. 3; pp. 973 - 980 |
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Main Authors | , , |
Format | Journal Article |
Language | English |
Published |
New York
Springer-Verlag
01.03.2013
Springer Nature B.V |
Subjects | |
Online Access | Get full text |
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Abstract | Background
The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V–Y advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. It is implied that the long-axis advancements enable closure by relaxing the entire flap of skin, allowing it to be stretched more easily along the short axis. We undertook a study to test this hypothesis.
Methods
We measured tension and extension along perpendicular axes in nine freshly excised specimens of human skin. We held the longitudinal axis fixed while stretching the skin along the transverse axis. We then released the longitudinal axis and measured the resultant drop in transverse tension. Finally, we increased the transverse tension to approximately its previous level, and measured the new transverse extension.
Results
There was significant interdependence between longitudinal and transverse tensions. The fall in transverse wound tension associated with longitudinal release varied with starting tensions and with the original site and orientation of the specimen. In the five cases where the longitudinal release was from the in vivo length, the mean increase in transverse stretch attributable to the release was 0.6 mm (95 % confidence interval 0.1–1.1 mm).
Discussion
The increase in transverse stretch that can be achieved by releasing skin from its longitudinal in vivo length appears trivial, raising questions about the rationale for the use of the prototypical (type 1) keystone flap in wound closure. |
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AbstractList | Background
The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V–Y advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. It is implied that the long-axis advancements enable closure by relaxing the entire flap of skin, allowing it to be stretched more easily along the short axis. We undertook a study to test this hypothesis.
Methods
We measured tension and extension along perpendicular axes in nine freshly excised specimens of human skin. We held the longitudinal axis fixed while stretching the skin along the transverse axis. We then released the longitudinal axis and measured the resultant drop in transverse tension. Finally, we increased the transverse tension to approximately its previous level, and measured the new transverse extension.
Results
There was significant interdependence between longitudinal and transverse tensions. The fall in transverse wound tension associated with longitudinal release varied with starting tensions and with the original site and orientation of the specimen. In the five cases where the longitudinal release was from the in vivo length, the mean increase in transverse stretch attributable to the release was 0.6 mm (95 % confidence interval 0.1–1.1 mm).
Discussion
The increase in transverse stretch that can be achieved by releasing skin from its longitudinal in vivo length appears trivial, raising questions about the rationale for the use of the prototypical (type 1) keystone flap in wound closure. BACKGROUNDThe keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V-Y advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. It is implied that the long-axis advancements enable closure by relaxing the entire flap of skin, allowing it to be stretched more easily along the short axis. We undertook a study to test this hypothesis.METHODSWe measured tension and extension along perpendicular axes in nine freshly excised specimens of human skin. We held the longitudinal axis fixed while stretching the skin along the transverse axis. We then released the longitudinal axis and measured the resultant drop in transverse tension. Finally, we increased the transverse tension to approximately its previous level, and measured the new transverse extension.RESULTSThere was significant interdependence between longitudinal and transverse tensions. The fall in transverse wound tension associated with longitudinal release varied with starting tensions and with the original site and orientation of the specimen. In the five cases where the longitudinal release was from the in vivo length, the mean increase in transverse stretch attributable to the release was 0.6 mm (95% confidence interval 0.1-1.1 mm).DISCUSSIONThe increase in transverse stretch that can be achieved by releasing skin from its longitudinal in vivo length appears trivial, raising questions about the rationale for the use of the prototypical (type 1) keystone flap in wound closure. The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V-Y advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. It is implied that the long-axis advancements enable closure by relaxing the entire flap of skin, allowing it to be stretched more easily along the short axis. We undertook a study to test this hypothesis. We measured tension and extension along perpendicular axes in nine freshly excised specimens of human skin. We held the longitudinal axis fixed while stretching the skin along the transverse axis. We then released the longitudinal axis and measured the resultant drop in transverse tension. Finally, we increased the transverse tension to approximately its previous level, and measured the new transverse extension. There was significant interdependence between longitudinal and transverse tensions. The fall in transverse wound tension associated with longitudinal release varied with starting tensions and with the original site and orientation of the specimen. In the five cases where the longitudinal release was from the in vivo length, the mean increase in transverse stretch attributable to the release was 0.6 mm (95% confidence interval 0.1-1.1 mm). The increase in transverse stretch that can be achieved by releasing skin from its longitudinal in vivo length appears trivial, raising questions about the rationale for the use of the prototypical (type 1) keystone flap in wound closure. The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V-Y advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. It is implied that the long-axis advancements enable closure by relaxing the entire flap of skin, allowing it to be stretched more easily along the short axis. We undertook a study to test this hypothesis. We measured tension and extension along perpendicular axes in nine freshly excised specimens of human skin. We held the longitudinal axis fixed while stretching the skin along the transverse axis. We then released the longitudinal axis and measured the resultant drop in transverse tension. Finally, we increased the transverse tension to approximately its previous level, and measured the new transverse extension. There was significant interdependence between longitudinal and transverse tensions. The fall in transverse wound tension associated with longitudinal release varied with starting tensions and with the original site and orientation of the specimen. In the five cases where the longitudinal release was from the in vivo length, the mean increase in transverse stretch attributable to the release was 0.6 mm (95 % confidence interval 0.1-1.1 mm). The increase in transverse stretch that can be achieved by releasing skin from its longitudinal in vivo length appears trivial, raising questions about the rationale for the use of the prototypical (type 1) keystone flap in wound closure.[PUBLICATION ABSTRACT] |
Author | Low, Nelson C. K. Douglas, Charles D. Seitz, Michael J. |
Author_xml | – sequence: 1 givenname: Charles D. surname: Douglas fullname: Douglas, Charles D. email: charles.douglas@newcastle.edu.au organization: Discipline of Surgical Science, The University of Newcastle – sequence: 2 givenname: Nelson C. K. surname: Low fullname: Low, Nelson C. K. organization: Calvary Mater Hospital – sequence: 3 givenname: Michael J. surname: Seitz fullname: Seitz, Michael J. organization: John Hunter Hospital |
BackLink | https://www.ncbi.nlm.nih.gov/pubmed/23054120$$D View this record in MEDLINE/PubMed |
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Cites_doi | 10.1016/j.suc.2009.03.004 10.1016/0738-081X(95)00078-T 10.1016/j.bjps.2008.08.078 10.1111/j.1445-2197.2011.05772.x 10.1046/j.1445-2197.2003.02661.x 10.1146/annurev.bioeng.5.011303.120714 10.1245/s10434-008-0018-8 10.1111/j.1445-2197.2006.03958.x 10.1016/j.bjps.2007.01.072 10.1016/0021-9290(76)90107-X 10.1111/j.1445-2197.2011.05833.x 10.1245/s10434-008-0126-5 10.1016/j.bjps.2007.03.023 10.1016/1350-4533(95)90856-7 10.1016/0021-9290(79)90027-7 10.1111/j.1445-2197.2009.05127.x 10.1111/j.1445-2197.2010.05392.x 10.1016/j.bjps.2009.06.028 10.1046/j.1445-2197.2003.02638.x 10.1097/PRS.0b013e318205f36f 10.1109/IEMBS.2004.1404408 |
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Keywords | Primary Closure Longitudinal Shrinkage Keystone Island Flap Transverse Axis |
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References | Reihsner, Balogh, Menzel (CR14) 1995; 17 Behan, Sizeland (CR21) 2006; 76 Moncrieff, Thompson, Stretch (CR4) 2009; 63 Edwards, Marks (CR10) 1995; 13 Rao, Raine (CR20) 2010; 80 Lanir (CR13) 1979; 12 Jackson (CR9) 2003; 73 Pelissier, Gardet, Pinsolle, Santoul, Behan (CR16) 2007; 60 Shipkov, Mojallal (CR5) 2008; 15 CR15 Behan, Lo, Shayan (CR17) 2009; 62 Kim, Kim (CR19) 2011; 40 Moncrieff, Bowen, Thompson (CR7) 2008; 15 Pelissier, Santoul, Pinsolle, Casoli, Behan (CR2) 2007; 60 Sacks, Sun (CR11) 2003; 5 Behan, Lo (CR18) 2009; 79 Behan, Rozen, Lo, Findlay (CR22) 2011; 81 Tschoi, Hoi, Granick (CR1) 2009; 89 Khouri, Egeland, Daily (CR6) 2011; 127 Behan (CR3) 2003; 73 Tong, Fung (CR12) 1976; 9 Behan, Rozen, Kapila, Ng (CR8) 2011; 81 Y Lanir (2684_CR13) 1979; 12 FC Behan (2684_CR8) 2011; 81 2684_CR15 IT Jackson (2684_CR9) 2003; 73 C Edwards (2684_CR10) 1995; 13 FC Behan (2684_CR17) 2009; 62 M Tschoi (2684_CR1) 2009; 89 JS Khouri (2684_CR6) 2011; 127 MD Moncrieff (2684_CR7) 2008; 15 P Pelissier (2684_CR16) 2007; 60 P Kim (2684_CR19) 2011; 40 C Shipkov (2684_CR5) 2008; 15 P Pelissier (2684_CR2) 2007; 60 R Reihsner (2684_CR14) 1995; 17 FC Behan (2684_CR3) 2003; 73 M Sacks (2684_CR11) 2003; 5 FC Behan (2684_CR21) 2006; 76 K Rao (2684_CR20) 2010; 80 P Tong (2684_CR12) 1976; 9 FC Behan (2684_CR22) 2011; 81 MD Moncrieff (2684_CR4) 2009; 63 FC Behan (2684_CR18) 2009; 79 |
References_xml | – volume: 89 start-page: 643 year: 2009 end-page: 658 ident: CR1 article-title: Skin flaps publication-title: Surg Clin North Am. doi: 10.1016/j.suc.2009.03.004 contributor: fullname: Granick – volume: 13 start-page: 375 year: 1995 end-page: 380 ident: CR10 article-title: Evaluation of biomechanical properties of human skin publication-title: Clin Dermatol. doi: 10.1016/0738-081X(95)00078-T contributor: fullname: Marks – volume: 62 start-page: 551 year: 2009 end-page: 553 ident: CR17 article-title: Perforator territory of the keystone flap—use of the dermatomal roadmap publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2008.08.078 contributor: fullname: Shayan – volume: 40 start-page: 224 year: 2011 end-page: 225 ident: CR19 article-title: S-plasty—clinical applications for skin surgery publication-title: Aust Fam Physician. contributor: fullname: Kim – volume: 81 start-page: 405 year: 2011 end-page: 406 ident: CR8 article-title: Two for the price of one: a keystone design equals two conjoined V-Y flaps publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2011.05772.x contributor: fullname: Ng – volume: 73 start-page: 261 year: 2003 ident: CR9 article-title: The keystone design perforator island flap in reconstructive surgery publication-title: ANZ J Surg. doi: 10.1046/j.1445-2197.2003.02661.x contributor: fullname: Jackson – volume: 5 start-page: 251 year: 2003 end-page: 284 ident: CR11 article-title: Multiaxial mechanical behaviour of biological materials publication-title: Annu Rev Biomed Eng. doi: 10.1146/annurev.bioeng.5.011303.120714 contributor: fullname: Sun – volume: 15 start-page: 2867 year: 2008 end-page: 2873 ident: CR7 article-title: Keystone flap reconstruction of primary melanoma excision defects of the leg—the end of the skin graft? publication-title: Ann Surg Oncol doi: 10.1245/s10434-008-0018-8 contributor: fullname: Thompson – ident: CR15 – volume: 76 start-page: 1127 year: 2006 end-page: 1129 ident: CR21 article-title: Reiteration of core principles of the keystone island flap publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2006.03958.x contributor: fullname: Sizeland – volume: 60 start-page: 883 year: 2007 end-page: 887 ident: CR2 article-title: The keystone design perforator island flap. Part I: anatomic study publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2007.01.072 contributor: fullname: Behan – volume: 9 start-page: 649 year: 1976 end-page: 657 ident: CR12 article-title: The stress–strain relationship for the skin publication-title: J Biomech. doi: 10.1016/0021-9290(76)90107-X contributor: fullname: Fung – volume: 81 start-page: 650 year: 2011 end-page: 652 ident: CR22 article-title: Keystone design flap: a tension-reducing modification (Re: 2010;80:574) publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2011.05833.x contributor: fullname: Findlay – volume: 15 start-page: 3625 year: 2008 ident: CR5 article-title: The keystone island and pedicle flap: a handy local flap for soft tissue reconstruction publication-title: Ann Surg Oncol. doi: 10.1245/s10434-008-0126-5 contributor: fullname: Mojallal – volume: 60 start-page: 888 year: 2007 end-page: 891 ident: CR16 article-title: The keystone design perforator island flap. Part II: clinical applications publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2007.03.023 contributor: fullname: Behan – volume: 17 start-page: 304 year: 1995 end-page: 313 ident: CR14 article-title: Two-dimensional elastic properties of human skin in terms of an incremental model at the in vivo configuration publication-title: Med Eng Phys. doi: 10.1016/1350-4533(95)90856-7 contributor: fullname: Menzel – volume: 12 start-page: 423 year: 1979 end-page: 436 ident: CR13 article-title: A structural theory for the homogeneous biaxial stress–strain relationships in flat collagenous tissues publication-title: J Biomech. doi: 10.1016/0021-9290(79)90027-7 contributor: fullname: Lanir – volume: 79 start-page: 861 year: 2009 end-page: 862 ident: CR18 article-title: Vascular dynamics of the keystone island flap: ongoing observations similar to sympathectomy publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2009.05127.x contributor: fullname: Lo – volume: 80 start-page: 574 year: 2010 ident: CR20 article-title: Re: keystone design flap: a tension-reducing modification publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2010.05392.x contributor: fullname: Raine – volume: 63 start-page: 1359 year: 2009 end-page: 1363 ident: CR4 article-title: Extended experience and modifications in the design and concepts of the keystone design island flap publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2009.06.028 contributor: fullname: Stretch – volume: 73 start-page: 112 year: 2003 end-page: 120 ident: CR3 article-title: The keystone design perforator island flap in reconstructive surgery publication-title: ANZ J Surg. doi: 10.1046/j.1445-2197.2003.02638.x contributor: fullname: Behan – volume: 127 start-page: 1212 year: 2011 end-page: 1221 ident: CR6 article-title: The keystone island flap: use in large defects of the trunk and extremities in soft tissue reconstruction publication-title: Plast Reconstr Surg. doi: 10.1097/PRS.0b013e318205f36f contributor: fullname: Daily – volume: 73 start-page: 112 year: 2003 ident: 2684_CR3 publication-title: ANZ J Surg. doi: 10.1046/j.1445-2197.2003.02638.x contributor: fullname: FC Behan – volume: 79 start-page: 861 year: 2009 ident: 2684_CR18 publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2009.05127.x contributor: fullname: FC Behan – volume: 73 start-page: 261 year: 2003 ident: 2684_CR9 publication-title: ANZ J Surg. doi: 10.1046/j.1445-2197.2003.02661.x contributor: fullname: IT Jackson – volume: 9 start-page: 649 year: 1976 ident: 2684_CR12 publication-title: J Biomech. doi: 10.1016/0021-9290(76)90107-X contributor: fullname: P Tong – volume: 12 start-page: 423 year: 1979 ident: 2684_CR13 publication-title: J Biomech. doi: 10.1016/0021-9290(79)90027-7 contributor: fullname: Y Lanir – ident: 2684_CR15 doi: 10.1109/IEMBS.2004.1404408 – volume: 81 start-page: 650 year: 2011 ident: 2684_CR22 publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2011.05833.x contributor: fullname: FC Behan – volume: 89 start-page: 643 year: 2009 ident: 2684_CR1 publication-title: Surg Clin North Am. doi: 10.1016/j.suc.2009.03.004 contributor: fullname: M Tschoi – volume: 62 start-page: 551 year: 2009 ident: 2684_CR17 publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2008.08.078 contributor: fullname: FC Behan – volume: 80 start-page: 574 year: 2010 ident: 2684_CR20 publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2010.05392.x contributor: fullname: K Rao – volume: 127 start-page: 1212 year: 2011 ident: 2684_CR6 publication-title: Plast Reconstr Surg. doi: 10.1097/PRS.0b013e318205f36f contributor: fullname: JS Khouri – volume: 15 start-page: 2867 year: 2008 ident: 2684_CR7 publication-title: Ann Surg Oncol doi: 10.1245/s10434-008-0018-8 contributor: fullname: MD Moncrieff – volume: 5 start-page: 251 year: 2003 ident: 2684_CR11 publication-title: Annu Rev Biomed Eng. doi: 10.1146/annurev.bioeng.5.011303.120714 contributor: fullname: M Sacks – volume: 15 start-page: 3625 year: 2008 ident: 2684_CR5 publication-title: Ann Surg Oncol. doi: 10.1245/s10434-008-0126-5 contributor: fullname: C Shipkov – volume: 60 start-page: 888 year: 2007 ident: 2684_CR16 publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2007.03.023 contributor: fullname: P Pelissier – volume: 76 start-page: 1127 year: 2006 ident: 2684_CR21 publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2006.03958.x contributor: fullname: FC Behan – volume: 60 start-page: 883 year: 2007 ident: 2684_CR2 publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2007.01.072 contributor: fullname: P Pelissier – volume: 63 start-page: 1359 year: 2009 ident: 2684_CR4 publication-title: J Plast Reconstr Aesthet Surg. doi: 10.1016/j.bjps.2009.06.028 contributor: fullname: MD Moncrieff – volume: 17 start-page: 304 year: 1995 ident: 2684_CR14 publication-title: Med Eng Phys. doi: 10.1016/1350-4533(95)90856-7 contributor: fullname: R Reihsner – volume: 13 start-page: 375 year: 1995 ident: 2684_CR10 publication-title: Clin Dermatol. doi: 10.1016/0738-081X(95)00078-T contributor: fullname: C Edwards – volume: 81 start-page: 405 year: 2011 ident: 2684_CR8 publication-title: ANZ J Surg. doi: 10.1111/j.1445-2197.2011.05772.x contributor: fullname: FC Behan – volume: 40 start-page: 224 year: 2011 ident: 2684_CR19 publication-title: Aust Fam Physician. contributor: fullname: P Kim |
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The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V–Y... The keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V-Y advancements... BACKGROUNDThe keystone flap is being promoted as an advance in oncological surgical reconstruction. Wound closure with this island flap involves two V-Y... |
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SubjectTerms | Female Humans Male Medicine Medicine & Public Health Oncology Prognosis Reconstructive Oncology Reconstructive Surgical Procedures Skin Neoplasms - pathology Skin Neoplasms - surgery Surgery Surgical Flaps Surgical Oncology Wound Healing |
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Title | The Keystone Flap: Not an Advance, Just a Stretch |
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