{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:51:08Z","timestamp":1791931868924,"version":"4.3.4"},"reference-count":11,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2024,11]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose and Background:<\/jats:title>\n                    <jats:p>To create awareness among dermatosurgeons about the versatility of keystone flaps in re-surfacing post-excisional small, medium and large skin defects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Aims and Objectives:<\/jats:title>\n                    <jats:p>Single-staged tension-free re-surfacing of various sized skin defects using keystone flap and to have least donor site morbidity, primary healing and maximum functional outcome.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Material and Methods:<\/jats:title>\n                    <jats:p>\n                      This retrospective study was conducted, between October 2021 \u2013 January 2023 in Department of Plastic Surgery, PGIMS Rohtak, on 15 males and 1 female aged between 18 - 65 years. Sixteen Keystone flaps (type IIA\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =13, Omega cum Sydney melanoma unit modification\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =3) were utilized for resurfacing skin defects arising after excision of basal cell carcinoma (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =3) and benign hairy nevus (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =2) on cheek, basal cell carcinoma forehead (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =1), electric burns on deltoid (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =2), giant neurofibroma back (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =1), tattoo forearm (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =3), chronic non-specific granuloma thumb (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =2) and pilonidal sinus disease (\n                      <jats:italic toggle=\"yes\">n<\/jats:italic>\n                      =2). Skin with maximum expansibility was chosen as donor site with utmost care of facial lines and its aesthetic subunits. Flaps were dissected all around preserving maximum number of hand-held Doppler-identified perforators in pedicular area. Sutures were removed on 10th to 15th post-operative day. Follow-ups ranged from 2 to 15 months.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>None had wound dehiscence or loss of flap.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Keystone flaps have defect-adaptive design, simple bio-geometry, technical simplicity, decreased downtime, cost effectivity and efficiency and can be designed to resurface post-excisional skin defect from head to toe with acceptable results, therefore should strongly be considered by dermatosurgeons while excising skin lesions.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.4103\/ijd.ijd_953_23","type":"journal-article","created":{"date-parts":[[2024,8,19]],"date-time":"2024-08-19T02:00:18Z","timestamp":1724032818000},"page":"432-441","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":1,"title":["Utility of Keystone Flap in Armory of Dermatosurgeons"],"prefix":"10.4103","volume":"69","author":[{"given":"Abhinav","family":"Singh","sequence":"first","affiliation":[{"name":"From the Department of Burns and Plastic Surgery, AIIMS, Saket Nagar, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rohini","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Dermatology and Venereology, Bhagwandas Hospital, Sonipat, Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaurav","family":"Chaturvedi","sequence":"additional","affiliation":[{"name":"From the Department of Burns and Plastic Surgery, AIIMS, Saket Nagar, Bhopal, Madhya Pradesh, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Malika","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of GI Surgery, Dharamshila Narayana Superspeciality Hospital, Delhi, India"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"RB","family":"Singh","sequence":"additional","affiliation":[{"name":"Department of Burns and Plastic Surgery and Hypospadias and VVFs Clinic, Postgraduate Institute of Medical Sciences (PGIMS), University of Health Sciences, Rohtak (UHSR), Haryana, India"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2024,10,29]]},"reference":[{"key":"R1-20241101","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1046\/j.1445-2197.2003.02638.x","article-title":"The Keystone design perforator island flap in reconstructive surgery","volume":"73","author":"Behan","year":"2003","journal-title":"ANZJ Surg"},{"key":"R2-20241101","first-page":"1293","article-title":"Keystone perforator island flaps in major head and neck surgery \u2013The P. 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E. perspectives","volume":"4","author":"Behan","year":"2021","journal-title":"World J Surg Surg Res"},{"key":"R3-20241101","doi-asserted-by":"crossref","first-page":"e14167","DOI":"10.1097\/MD.0000000000014167","article-title":"Relaxed skin tension line\u2013oriented keystone\u2013designed perforator island flaps considering the facial aesthetic unit concept for the coverage of small to moderate facial defects","volume":"98","author":"Yoon","year":"2019","journal-title":"Medicine"},{"key":"R4-20241101","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.12998\/wjcc.v8.i10.1832","article-title":"Keystone design perforator island flap in facial defect reconstruction","volume":"8","author":"Lim","year":"2020","journal-title":"World J Clin Cases"},{"key":"R5-20241101","doi-asserted-by":"crossref","first-page":"1359","DOI":"10.1016\/j.bjps.2009.06.028","article-title":"Extended experience and modifications in the design and concepts of the keystone design island flap","volume":"63","author":"Moncrieff","year":"2010","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"R6-20241101","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/j.1445-2197.2011.05833.x","article-title":"The omega-?-variant designs (type A and B) of the keystone perforator island flap","volume":"81","author":"Behan","year":"2011","journal-title":"ANZ J Surg"},{"key":"R7-20241101","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.bjps.2007.03.023","article-title":"The keystone design perforator island flap. Part II:Clinical applications","volume":"60","author":"Pelissier","year":"2007","journal-title":"J Plast Reconstr Aesthet Surg"},{"key":"R8-20241101","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1097\/PRS.0000000000002228","article-title":"Evolving concepts of keystone perforator island flaps (KPIF):Principles of perforator anatomy, design modifications, and extended clinical applications","volume":"137","author":"Mohan","year":"2016","journal-title":"Plast Reconstr Surg"},{"key":"R9-20241101","doi-asserted-by":"crossref","first-page":"e2126","DOI":"10.1097\/GOX.0000000000002126","article-title":"Keystone flap:Overcoming paradigms","volume":"7","author":"Gomez","year":"2019","journal-title":"Plast Reconstr Surg Glob Open"},{"key":"R10-20241101","doi-asserted-by":"crossref","first-page":"113","DOI":"10.1016\/0007-1226(87)90185-8","article-title":"The vascular territories (angiosomes) of the body:Experimental study and clinical applications","volume":"40","author":"Taylor","year":"1987","journal-title":"Br J Plast Surg"},{"key":"R11-20241101","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1097\/BCR.0B013E318031A172","article-title":"Management of postburn contractures of the upper extremity","volume":"28","author":"Schwarz","year":"2007","journal-title":"J Burn Care Res"}],"container-title":["Indian Journal of Dermatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.4103\/ijd.ijd_953_23","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T15:42:32Z","timestamp":1787067752000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.4103\/ijd.ijd_953_23"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,10,29]]},"references-count":11,"journal-issue":{"issue":"6","published-print":{"date-parts":[[2024]]}},"URL":"https:\/\/doi.org\/10.4103\/ijd.ijd_953_23","relation":{},"ISSN":["0019-5154","1998-3611"],"issn-type":[{"value":"0019-5154","type":"print"},{"value":"1998-3611","type":"electronic"}],"subject":[],"published":{"date-parts":[[2024,10,29]]},"assertion":[{"value":"2023-10-01","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2024-04-01","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}