Assessment of outcomes in donor site closure of anterolateral thigh flap with keystone flap

Keystone flap for ALTF donor site

Abstract

Background: After harvesting an anterolateral thigh (ALT) flap, closing the donor site too tightly can lead to problems or require skin grafting, which can impact both the structural and cosmetic results. The Keystone Perforator Island Flap (KPIF) is a reliable alternative to tension-free closure that preserves contour and reduces morbidity.

Objective: To look at the KPIF method for closing the donor site after harvesting a free ALT flap and see how safe, reliable, and attractive it is, as well as its results and problems.

Methodology: This study was conducted from 01 June 2024 to 30 November 2025 (18 months), at the Plastic Surgery Department of Fauji Foundation Hospital, Rawalpindi. This was a prospective descriptive cohort study. The study comprised consecutive patients undergoing donor-site closure for KPIF. In the first two weeks after surgery, the attributes such as demographic information, surgery details, and early postoperative problems were recorded. These problems included seroma, hematoma, epidermolysis, wound dehiscence, flap necrosis, and compartment syndrome. As part of a standard follow-up after three and six months of surgery, patients filled out structured questionnaires and underwent clinical examination. The examination comprised of checking for contour deformity, sensory symptoms like tingling or numbness, differences in thigh circumference compared to the other leg, and evaluating the quality of the scar using the Vancouver Scar Scale.

Results: Our study included 28 patients, with an average age of 41±15 years, an average BMI of 20±1.2 kg/m², and 57.1% of them were women. In all cases, closure without any major complications was achieved. In 14.3% of cases, minor complications were seen and were managed conservatively. Measurements of thigh circumference showed no significant difference compared to the other limb, and most people said they had mild sensory problems. At three months, 85.7% rated the cosmetic results as good or excellent, and 42.9% of the patients as per the structured questionnaire, showed a contour deformity.

Conclusion: Closing the ALT donor site with KPIF is safe, effective, and looks good. It keeps the structure of the site intact and lowers the risk of problems.