JAAD OnlineSurgical pearlMiniaturizing the keystone flap: An alternative to helical crus reconstruction after tumor surgery
Section snippets
Surgical challenge
There are limited reconstructive options for soft-tissue defects of the helical crus, which is an area that is known for thin skin, densely adherent to the perichondrium, and devoid of subcutaneous tissue.1 Although small defects may heal by second intention, be repaired primarily, or be excised as a wedge, larger wounds require combined flaps and grafts. We propose the use of a miniaturized keystone flap as an alternative to reconstruction of the auricular helical crus defect.
Solution
In this area, a miniaturized keystone flap can be prepared by initially converting the defect to an elliptical excision. The flap is designed in the cranial preauricular skin tissue area, which is characterized by good tissue laxity and vascularization by the superficial auricular artery (Fig 1, A and B).2 Incision of the flap is performed parallel to the lateral border of the defect, at a 90-degree angle and with a flap width and length identical to those of the primary defect. After minimal
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Cited by (0)
Funding sources: None.
Conflicts of interest: None disclosed.
Reprints not available from the authors.