Utility and Outcomes of the Keystone Perforator Island Flap for the Reconstruction of Various Anatomical Locations: A Prospective Study

Abstract

Background In Yemen's resource-constrained setting, the incidence of wounds resulting from injuries and accidents is high, placing a significant burden on the limited plastic surgery infrastructure. Advanced centers for microsurgical reconstruction are lacking, and expertise in free flaps is limited. Local flaps, while widely used, are complex and associated with high complication rates. This study evaluated the effectiveness and outcomes of the Keystone Island perforator flap (KIPF) technique as an alternative method for soft tissue reconstruction. Methods This prospective study included 35 patients who underwent KPIF for various defects. Demographic characteristics, intraoperative variables, postoperative outcomes, and aesthetic outcomes (assessed via the Patient and Observer Scar Assessment Scale (POSAS)) were evaluated. Factors influencing success rates and complications were analyzed. Results The mean age of the patients was 29 ± 11.75 years, with males comprising 86% of the sample. Trauma was the leading cause of tissue defects (77.1%). The most common defect locations were the leg (57.14%) and foot (11.43%). The mean operative time was 73.57 minutes. Postoperatively, 26% of patients experienced complications, with flap dehiscence being the most common complication (11.43%). The flap survival rate was 97%, and complete wound healing was observed in 91.4% of the patients within a median of 16 days. Scar assessments indicated satisfactory aesthetic outcomes with minimal differences from those of normal skin. Conclusion The KIPF technique demonstrated high effectiveness and reliability in soft tissue reconstruction, particularly in settings with limited resources and expertise. Its ease of use, minimal postsurgical care, and high flap survival rates make it a valuable alternative to traditional methods. This study supports the adoption of KIPF as a standard practice in similar resource-constrained environments.