Current Controversies in Melanoma Treatment | Journal CME Article-Journal CME Article: Current Controversies in Melanoma Treatment V2

Video Transcription

This presentation demonstrates the usefulness of the keystone flap in reconstructing melanoma wide excision defects, particularly in the distal extremities.  This patient has a thick melanoma and is planned for a wide excision with a 2 cm margin. The defect is seen here.  The distal side is somewhat undermined, as are the wings of the keystone flap, which will later be discarded.  The V to Y closures inferiorly and superiorly help reduce the overall defect size. The keystone flap shown here is modified, leaving a trailing skin bridge intact.  Once the V to Y portions are closed, the flap is then advanced across the wound defect without undermining the keystone flap, keeping the perforators intact underneath.  The flap is inset with a few initial sutures, demonstrating redundancy in the overlapping wings. The wings are then marked and resected.  This shows the final result in a different patient with a similar defect.

Video Summary

The presentation highlights the effectiveness of the keystone flap technique in reconstructing large excision defects from melanoma, especially on distal extremities. The procedure involves a wide excision with a 2 cm margin, using a modified keystone flap with an intact trailing skin bridge and V to Y closures to minimize defect size. This method preserves the perforators under the flap, allowing it to be advanced without undermining. The final result illustrates effective reconstruction with marked and resected redundant wings, demonstrating successful application in another patient with a similar defect.

Keywords

keystone flap technique

melanoma reconstruction

distal extremities

V to Y closures

perforator preservation