Quadriceps keystone island flap for radical inguinal lymphadenectomy

A reliable locoregional island flap for large groin defects

Felix C. Behan, Alenka Paddle, Warren M. Rozen, Xuan Ye, David Speakman, Michael W. Findlay, Michael A. Henderson

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

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.

Original languageEnglish
Pages (from-to)942-947
Number of pages6
JournalANZ Journal of Surgery
Volume83
Issue number12
DOIs
Publication statusPublished - 2013
Externally publishedYes

Keywords

  • Groin defect
  • Keystone flap
  • Melanoma
  • Radical inguinal lymphandenectomy
  • Reconstruction

Cite this

Behan, Felix C. ; Paddle, Alenka ; Rozen, Warren M. ; Ye, Xuan ; Speakman, David ; Findlay, Michael W. ; Henderson, Michael A. / Quadriceps keystone island flap for radical inguinal lymphadenectomy : A reliable locoregional island flap for large groin defects. In: ANZ Journal of Surgery. 2013 ; Vol. 83, No. 12. pp. 942-947.
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title = "Quadriceps keystone island flap for radical inguinal lymphadenectomy: A reliable locoregional island flap for large groin defects",
abstract = "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.",
keywords = "Groin defect, Keystone flap, Melanoma, Radical inguinal lymphandenectomy, Reconstruction",
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Quadriceps keystone island flap for radical inguinal lymphadenectomy : A reliable locoregional island flap for large groin defects. / Behan, Felix C.; Paddle, Alenka; Rozen, Warren M.; Ye, Xuan; Speakman, David; Findlay, Michael W.; Henderson, Michael A.

In: ANZ Journal of Surgery, Vol. 83, No. 12, 2013, p. 942-947.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Quadriceps keystone island flap for radical inguinal lymphadenectomy

T2 - A reliable locoregional island flap for large groin defects

AU - Behan, Felix C.

AU - Paddle, Alenka

AU - Rozen, Warren M.

AU - Ye, Xuan

AU - Speakman, David

AU - Findlay, Michael W.

AU - Henderson, Michael A.

PY - 2013

Y1 - 2013

N2 - 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.

AB - 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.

KW - Groin defect

KW - Keystone flap

KW - Melanoma

KW - Radical inguinal lymphandenectomy

KW - Reconstruction

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U2 - 10.1111/j.1445-2197.2011.05790.x

DO - 10.1111/j.1445-2197.2011.05790.x

M3 - Article

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SP - 942

EP - 947

JO - ANZ Journal of Surgery

JF - ANZ Journal of Surgery

SN - 1445-1433

IS - 12

ER -