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Optimizing Reconstructive Outcomes: A Case Series of a Modified Keystone Island Perforator Flap for Pretibial Defects
Journal article   Open access   Peer reviewed

Optimizing Reconstructive Outcomes: A Case Series of a Modified Keystone Island Perforator Flap for Pretibial Defects

Aman Singh Sandhu, Mustafa Sami and Stephen Lu
Journal of Aesthetic Medicine, v 2(2), 11
12 Jun 2026
DOI: https://doi.org/10.3390/jaestheticmed2020011
Featured in Collection :   Research Supported by Drexel Libraries' OA Programs
url
https://doi.org/10.3390/jaestheticmed2020011View
Published, Version of Record (VoR) Open Access Discount via Drexel Libraries Read and Publish Program 2026 Open CC BY V4.0

Abstract

Aesthetics Plastic Surgery
Background: The Keystone Island Perforator Flap (KIPF) is a well-established reconstructive option for defect closures but poses challenges in regions with limited skin laxity, such as the pretibial region. This often leads to impaired wound healing and subpar cosmetic results. We examine a modified approach incorporating the fascial release technique to observe both functional and aesthetic outcomes. Methods: A retrospective review was conducted of 20 adult patients who underwent pretibial reconstruction with the modified KIPF at a single institution. All procedures were performed in an office setting under local anesthesia. Data on demographics, comorbidities, flap size, and postoperative outcomes was collected. Results: Patients ranged from 46 to 91 years of age (mean 69). The majority (60%) were female and nonsmokers (90%). Common comorbidities included hypertension (45%), hyperlipidemia (25%), and diabetes (10%). Most procedures (90%) were performed following oncologic excisions. Defect sizes ranged from 1.95 to 17.5 cm2. No intraoperative flap failures were seen. Two patients developed minor wound dehiscence, both managed conservatively. Complete wound healing was often seen within one month. Conclusion: The modified KIPF provides a safe, reliable method of pretibial reconstruction. Its low complication rate and feasibility under local anesthesia support its expanded use in anatomically constrained regions.

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