Application of Delayed Keystone Flap in Management of Post-Electrical Burn Squamous Cell Carcinoma.
Squamous cell carcinoma is one of the most common skin malignancies,
which may develop in any burn scar, traumatized, chronically inflamed scarred
skin or post-radiotherapy scars.
The incidence of chronic ulcers transforming into malignancy is 2% to 6%.2
The Keystone-designed flap is widely used for loco-regional reconstruction
or any defect which may be closed primarily.
The Keystone flap is one of the local flaps that facilitate the closure of defects
primarily without tension. It is simple, with better aesthetic
results and stable coverage.
Various other flaps have been described for reconstruction, including local,
regional, distant, and microvascular flaps.
The delay phenomenon, also called ischemic preconditioning,
describes the observation that a tissue rendered partially
ischemic will undergo neovascularization and enhance its vascularity.
The post-excision defect was 6 cm wide and 10 cm long.
Histopathology showed squamous cell carcinoma.
The future plan is to do the remaining delayed staged keystone
flap or transposition flap on the opposite side based on
the vascularity and clinical judgement.
The Keystone flap is one of the local flaps that facilitate the closure of defects
primarily without tension. It is usually a curvilinear
shaped, trapezoidal designed flap. It is essentially two V-Y flaps,
end to side.
In our study, we decided to choose Type 3 delayed keystone flaps. Pelissier et al6
have described it as universally applicable
and extremely reliable for defects from head to toe.
Dermatol Open J. 2022; 7(1): 9-11. doi: 10.17140/DRMTOJ-7-149