Maintenance of intact skin throughout the body is essential to prevent dehydration, to act as a barrier to infection, to allow unrestricted movement, and to provide a normal appearance. A flap is a piece of body tissue, usually skin and fat, that always has its own blood supply. Therefore, a flap can be moved anywhere it can reach without worrying about the circulation present at the place that needs it, which is called the recipient site. When compared with all other possible choices, a flap best meets all the requirements for any area needing skin replacement.
The keystone type flap as one such option is so named because its design has the shape of the keystone of a Roman arch. If taken from loose tissues adjacent to a defect, it can be simply cut and advanced for any necessary skin coverage. Direct closure of the donor site where this flap comes from is possible so that usually a quite good overall cosmetic result is also obtained. These virtues are shown as an overview in this video where a keystone flap is transferred after removal of a common basal cell skin cancer from the lower lip.
Resection of cutaneous malignancies may result in substantial skin defects. Often, skin grafting is a first-line option for reconstruction of such defects but may be limited by poor cosmetic outcomes and incomplete graft acceptance. Accordingly, skin flaps, tissue rearrangement techniques, and more complex procedures may be needed. This case report presents the successful use of a combination of nasolabial flap and rhomboid flap for reconstruction of a 3-cm × 2-cm left nasal sidewall and ala skin defect that remained following a basal cell cancer Mohs resection. The flaps were quickly and easily fashioned, did not require any special instruments, and resulted in a good cosmetic outcome. There were no wound complications and the flaps healed completely with excellent contour, texture, thickness, color match, and complete patient satisfaction. This case is an example of the technical aspects of successful planning, elevation, and inset of a nasolabial flap and rhomboid flap.
Geoffrey G. Hallock, MD Plastic Surgery Consultant Sacred Heart Campus, St. Luke’s Hospital Allentown, Pennsylvania
Yoko Young Sang, MD Resident Physician General Surgery Louisiana State University Shreveport
In this case, Dr. Hallock closes the wound that was left behind following a mastectomy using a latissimus dorsi musculocutaneous local flap. This was performed during a surgical mission in Honduras with the World Surgical Foundation.