PEDICLE BASED KEYSTONE ISLAND FLAPS : LARGE DEFECTS

SOFT TISSUE TUMOR RECONSTRUCTION, SERIAL CASE AT

SANGLAH GENERAL HOSPITAL, DENPASAR
I Made Dwi Purnamantara1 , I.B Made Suryawisesa2

1 GeneralSurgery Training Program Medical Faculty of Udayana University, Sanglah General Hospital Denpasar, Bali, Indonesia
2 Sub Division of Surgical Oncology, Surgery Department, Medical Faculty of Udayana University Sanglah General Hospital

Denpasar, Bali, Indonesia

BACKGROUND
Closing a defect after tumor resection is a
mainstream procedure in reconstructive surgery.
There is a wide selection of available reconstruction
techniques, one of which is the Keystone island
flaps. Keystone Island flaps is a fairly new concept
that takes the skin and superficial fascia with a
keystone pattern adjacent to the defect to be closed.
The vascularization of this flap originates from the
subcutaneous vascular tissue and depends on the
perforator of the fascia and muscle. The purpose of
this serialized case report is intended to discuss a
large defects not necessarily in need of a free flap,
but with a keystone flap giving good results

CASE REPORT CONCLUSION

First case was male, 68 years old, treated at Sanglah
A case of large size tumor can cause a large
General Hospital (RSUP) with tumor on the
defect problems during surgery. Closing this
abdominal wall since 2 years ago. Diagnosis is made
with tumor tissue biopsy and CT scan to determine defect is a very challenging for surgeon.
tumor boundary. conclusions found in low grade Keystone island flap is a technique that is quite
spindle cell tumors, already performed wide excision beneficial because of the many braided
of tumors and extensive defects that were closed with vascularization and can simplify and shorten the
Keystone Island Flaps techniques. The second case duration of surgery. Good wound care can also
was women, 37 years old, admitted to Sanglah provide good outcomes.
General Hospital (RSUP) with dermatofibrosarcoma
at posterior thoracic region. Patients have done wide
excision of tumor and defect was close using
Keystone Island Flaps.

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