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.
Sandhu et al. (Fri,) studied this question.