None listed
Conditions
Brief summary
Surgical defeects that are predicted to be difficult to close may be considered for type one ketstone closure. The theoretical advantage of this method is that the release of the longitudinal tension in the wound allows greater stretch along the transverse axis. There is no reliable evidence in the literature to prove that this is the case in human models, indeed in our small study the increase in transverse stretch enabled by longitudinal release was less than 1mm. With this in mind the advantage of a keystone flap over other wound closure techniques is unclear. We aim to compare the keystone flap with simple primary wound closure, with primary outcome measured as wound healing, using the ASEPSIS wound score. The type one keystone flap was first described by Behan in 2003, for use in "suitable defects over most areas of the body up to 2cm in width". Patients will be recruited into the study based upon this selction criteria and then randomised to keystone flap or primary closure. Short and longterm follow up centered around the ASEPSIS wound score will be used to compare wound healing in the two groups.
Interventions
Type 1 Keystone flap as described by F Behan. A type of Perforator island flap - that is a tissue island which is separated from surrounding skin and hence relies on deep perforating vessels for it's blood supply. It is essentially elliptical in shape with its long axis adjacent to the long axis of the defect. The flap is based on randomly located vascular perforators. The wound is closed directly, the mid-line area is the line of maximum tension and by V-Y advancement of each end of the flap,
Type 1 Keystone flap as described by F Behan. A type of Perforator island flap - that is a tissue island which is separated from surrounding skin and hence relies on deep perforating vessels for it's blood supply. It is essentially elliptical in shape with its long axis adjacent to the long axis of the defect. The flap is based on randomly located vascular perforators. The wound is closed directly, the mid-line area is the line of maximum tension and by V-Y advancement of each end of the flap, the ‘islanded’ flap fills the defect. This allows the secondary defect on the opposite side to be closed, exploiting the mobility of the adjacent surrounding tissue. The technique can be found in the book 'The Keystone Perforator Island Flap Concept' by Felix Behan (Churchill Livingstone Australia, ISBN: 9780729539715. Approximate duration is 30-60 minutes.
Sponsors
Dr Charles Douglas
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to 100 Years
Healthy volunteers
No
Inclusion criteria
Patients undergoing surgical excision of skin lesion of which closure is suspected to be difficult. Intra-operative tension measurements will be taken and patients then stratified into tension-level groups for analysis.
Exclusion criteria
Children, pregnant women, those unable to consent.
Outcome results
None listed