TITLE:
Keystone Flap for Coverage of Myelomeningocele Defects: A Simple Solution to Complex Reconstructive Problem
AUTHORS:
Sherif A. Hantash, Mohamed H. El-Ghazaly, Wael H. Mahmoud, Mohamed M. Khedr
KEYWORDS:
Myelomeningocele, Keystone Flap, Perforator Flap, Island Flap
JOURNAL NAME:
Modern Plastic Surgery,
Vol.15 No.4,
October
24,
2025
ABSTRACT: Background: The management of myelomeningocele (MMC) defects poses significant reconstructive challenges. Numerous methods of reconstruction have been described. Nevertheless, the choice of the ideal reconstructive technique is still controversial. The keystone perforator island flap (KPIF), an emerging reconstructive option that is gaining popularity among reconstructive surgeons in many parts of the body. Herein, we aimed to evaluate the efficacy, safety, and surgical outcomes of using KPIF for the coverage of MMC defects. Methods: From April 2022 to April 2024, 16 consecutive newborns (10 male, 6 female) at a mean age of 4.4 days (1 - 15 days) with MMC defects were included in this prospective study. They underwent reconstruction using KPIF. The mean defect size was 5.6 × 5.1 cm (range, 4 × 4.5 cm to 8 × 6 cm). The defects were lumbar in 2 patients, thoracolumbar in 5 patients and lumbosacral in 9 patients. Operative time and early post-operative complications were recorded. Objective assessment regarding the durability of flaps and scar quality was done. Parents’ satisfaction with esthetic outcome was assessed. Results: Surgery time lasted between 60 and 110 minutes (mean: 83.8 minutes), excluding the neurosurgical repair. We used KPIF type III in 12 patients, and KPIF type IV -Omega variant in 4 patients. In all patients, tension-free closure was achieved, and healing was successful without any complications, except for 1 small wound dehiscence (Conclusions: The keystone flap is an ideal reconstructive option for MMC defect closure as it is simple, reliable, versatile, and cost-effective treatment modality, offering advantages over traditional methods by improving patient outcomes and minimizing complications.