{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,13]],"date-time":"2026-10-13T22:51:10Z","timestamp":1791931870987,"version":"4.3.4"},"reference-count":26,"publisher":"Georg Thieme Verlag KG","issue":"06","license":[{"start":{"date-parts":[[2022,3,25]],"date-time":"2022-03-25T00:00:00Z","timestamp":1648166400000},"content-version":"vor","delay-in-days":509,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2020,11,15]],"date-time":"2020-11-15T00:00:00Z","timestamp":1605398400000},"content-version":"tdm","delay-in-days":14,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["e-aps.org"],"crossmark-restriction":true},"short-container-title":["Arch Plast Surg"],"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>The keystone design perforator island flap can be utilized in the repair of trunk defects. A systematic review was carried out to identify the complication rates of the use of this flap to treat such defects. The MEDLINE, Embase, Cochrane Library, and PubMed Central databases were searched for articles published between January 2003 and December 2018 that reported the use of keystone design perforator island flaps in the repair of trunk defects. Study selection was conducted in alignment with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Eight articles involving a total of 54 flaps satisfied the inclusion criteria. The most frequently reported cause of trunk defects was oncologic resection (64.4%). The overall complication rate was 35.2%, and complications included infection (11.1%), wound dehiscence (7.4%), delayed healing (7.4%), and partial flap loss (1.9%). The keystone design perforator island flap is associated with a high success rate and low technical complexity. Despite minor complications, keystone design flaps could be a preferred choice for trunk reconstruction.<\/jats:p>","DOI":"10.5999\/aps.2020.00094","type":"journal-article","created":{"date-parts":[[2020,11,20]],"date-time":"2020-11-20T01:24:49Z","timestamp":1605835489000},"page":"535-541","update-policy":"https:\/\/doi.org\/10.5999\/crossmark_policy","source":"Crossref","is-referenced-by-count":19,"title":["A systematic review of the keystone design perforator island flap in the reconstruction of trunk defects"],"prefix":"10.1055","volume":"47","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4173-5911","authenticated-orcid":false,"given":"Irena Sakura","family":"Rini","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Dharmais Cancer Hospital, West Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0169-795X","authenticated-orcid":false,"given":"Alberta Jesslyn","family":"Gunardi","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Dharmais Cancer Hospital, West Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8294-2090","authenticated-orcid":false,"given":"Renate Parlene","family":"Marsaulina","sequence":"additional","affiliation":[{"name":"Department of Plastic Surgery, Dharmais Cancer Hospital, West Jakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1143-4125","authenticated-orcid":false,"given":"Teguh","family":"Aryandono","sequence":"additional","affiliation":[{"name":"Divisions of Oncology Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8270-2804","authenticated-orcid":false,"given":"Ishandono","family":"Dachlan","sequence":"additional","affiliation":[{"name":"Divisions of Plastic and Reconstructive Surgery, Department of Surgery, Dr. Sardjito Hospital, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9064-9687","authenticated-orcid":false,"given":"Iwan","family":"Dwiprahasto","sequence":"additional","affiliation":[{"name":"Department of Pharmacology and Therapy, Faculty of Medicine, Public Health and Nursing, Universitas Gadjah Mada, Yogyakarta, Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"194","published-online":{"date-parts":[[2022,3,25]]},"reference":[{"key":"ref1","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":"FC Behan","year":"2003","journal-title":"ANZ J Surg"},{"key":"ref2","doi-asserted-by":"crossref","first-page":"36","DOI":"10.4103\/0970-0358.113705","article-title":"Keystone flaps in coloured skin: flap technology for the masses?","volume":"46","author":"SP Bhat","year":"2013","journal-title":"Indian J Plast Surg"},{"key":"ref3","doi-asserted-by":"crossref","first-page":"650","DOI":"10.1111\/j.1445-2197.2011.05833.x","article-title":"The omega - \u03a9 - variant designs (types A and B) of the keystone perforator island flap","volume":"81","author":"FC Behan","year":"2011","journal-title":"ANZ J Surg"},{"key":"ref4","doi-asserted-by":"crossref","first-page":"733","DOI":"10.1007\/s00381-017-3697-2","article-title":"Long-term follow-up for keystone design perforator island flap for closure of myelomeningocele","volume":"34","author":"C Donaldson","year":"2018","journal-title":"Childs Nerv Syst"},{"key":"ref5","doi-asserted-by":"crossref","first-page":"1212","DOI":"10.1097\/PRS.0b013e318205f36f","article-title":"The keystone island flap: use in large defects of the trunk and extremities in soft-tissue reconstruction","volume":"127","author":"JS Khouri","year":"2011","journal-title":"Plast Reconstr Surg"},{"key":"ref6","doi-asserted-by":"crossref","first-page":"e6842","DOI":"10.1097\/MD.0000000000006842","article-title":"A systematic review of the keystone design perforator island flap in lower extremity defects","volume":"96","author":"J Huang","year":"2017","journal-title":"Medicine (Baltimore)"},{"key":"ref7","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/j.ijsu.2010.02.007","article-title":"Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement","volume":"8","author":"D Moher","year":"2010","journal-title":"Int J Surg"},{"key":"ref8","doi-asserted-by":"crossref","first-page":"888","DOI":"10.1016\/j.bjps.2007.03.023","article-title":"The keystone design perforator island flap. 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