Abstract：
BACKGROUND:Previous publications have implied that the keystone flap provides mechanical benefits compared to primary closure. This has not been objectively demonstrated. METHODS:Elliptical defects were created in 'fresh-frozen' cadaveric specimens. Two approaches were used to investigate the potential mechanical benefits of keystone flaps. Experiment 1 (wound closure): 18 defects were incrementally enlarged until they could not be closed primarily either with a single 'midpoint' suture or with a continuous suture. Attempts were then made to close these wounds with island flaps: 13 keystone flaps (seven 'type IIA' and six 'Sydney Melanoma Unit (SMU) modification') and five V-Y flaps. Experiment 2 (tension reduction): 28 defects were fashioned to be 'closable' under high tension. The 'pre-flap tension' was measured with a single midpoint suture and tensiometer. Fourteen keystone flaps (seven type IIA and seven SMU modifications) and seven V-Y flaps were then developed and mobilized with no flap constructed on the remaining seven 'primary closure' wounds. The secondary defects resulting from flap mobilization were closed leaving the primary defect unsutured. The primary defect 'post-flap tension' was then measured using the same technique. RESULTS:For Experiment 1, V-Y flaps enabled closure in four of five 'unclosable' defects. Keystone flaps did not enable closure in any of the 13 cases (P < 0.001). For Experiment 2, the V-Y flap (n = 7) was the only group that produced a significant drop in wound tension across the primary defect (mean 'pre-flap' to 'post-flap' tension change: -53%, 95% CI: -67 to -39%, P < 0.001). CONCLUSION:The data raise questions about the biomechanical benefits of keystone flaps.
journal_name
ANZ J Surgjournal_title
ANZ journal of surgeryauthors
Donovan LC,Douglas CD,Van Helden Ddoi
10.1111/ans.14163subject
Has Abstractpub_date
2018-05-01 00:00:00pages
486-490issue
5eissn
1445-1433issn
1445-2197journal_volume
88pub_type
杂志文章abstract：BACKGROUND:Acute compartment syndrome is a well-described surgical emergency that requires immediate diagnosis and operative intervention. Vascular access-associated compartment syndrome is rarely reported in haemodialysis patients. The purpose of this article is to document evidence that catheter-related puncture, whi...
journal_title：ANZ journal of surgery
pub_type： 杂志文章
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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更新日期：2020-01-01 00:00:00
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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journal_title：ANZ journal of surgery
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更新日期：2016-04-01 00:00:00
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pub_type： 临床试验,杂志文章
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更新日期：2017-09-01 00:00:00
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journal_title：ANZ journal of surgery
pub_type： 杂志文章
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更新日期：2019-06-01 00:00:00
