F. C. Behan MBBS, FRACS; A. Paddle MBBS; W. M. Rozen MBBS, BMedSc, PGDipSurgAnat, PhD; X. Ye; D. Speakman MBBS, FRACS; M. W. Findlay MBBS, PhD, FRACS; M. A. Henderson MBBS, BMedSc, MD, FRACS.
Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects
Article first published online: 17 MAY 2011
© 2011 The Authors. ANZ Journal of Surgery © 2011 Royal Australasian College of Surgeons
ANZ Journal of Surgery
Volume 83, Issue 12, pages 942–947, December 2013
How to Cite
Behan, F. C., Paddle, A., Rozen, W. M., Ye, X., Speakman, D., Findlay, M. W. and Henderson, M. A. (2013), Quadriceps keystone island flap for radical inguinal lymphadenectomy: a reliable locoregional island flap for large groin defects. ANZ Journal of Surgery, 83: 942–947. doi: 10.1111/j.1445-2197.2011.05790.x
- Issue published online: 2 DEC 2013
- Article first published online: 17 MAY 2011
- Accepted for publication 27 March 2011.
- keystone flap;
- groin defect;
- radical inguinal lymphandenectomy;
Background: Radical inguinal lymphadenectomy (RIL) for bulky metastatic melanoma and non-melanoma skin cancers of the inguinal region, while shown to improve morbidity and survival oncologically, can result in substantial morbidity from wound complications. Skin defects cannot be closed primarily and the substantial dead space predisposes to seroma, wound dehiscence and infection. Despite the clear need for reconstructive options, extended series describing reconstruction of large inguinal defects in this setting have not been reported.
Methods: A prospectively entered, retrospectively reviewed study of 20 consecutive patients undergoing quadriceps keystone island flaps (QKIF) for the closure of complicated inguinal defects is described.
Results: There was 100% flap survival, with no partial or complete flap losses. A reduction in wound breakdown/dehiscence from reported rates was seen, with four patients (20%) having wound breakdown, compared to double that rate in reported series. Other wound complications comprised six patients (30%) with mild wound infections, seven patients (35%) with seromas and two patients (10%) with haematomas.
Conclusion: The QKIF is an effective means of reconstructing inguinal defects after RIL, particularly in high-risk patients, and is technically simpler than other reconstructive techniques advocated for this purpose. Furthermore, the QKIF offers patients with advanced disease (where management is primarily palliative) a potentially improved quality of life with reduced operative morbidity.