JUSINDO, Vol. 7 No. 1, Januari 2025

p-ISSN: 2303-288X, e-ISSN: 2541-7207

Jurnal Sehat Indonesia: Vol. 7, No. 1, Januari 2025 | 70

A Keystone Flap as A Reconstructive Option for Anterior Abdominal and

Inguinal Defect

Andly Resando Mallo

, Mendy Hatibie Oley

Coresponden Author: Andly Resando Mallo

Abdominal wall defects are conditions where there is an abnormality or defect in the

structure of the abdominal wall, which can be caused by various factors such as congenital

abnormalities, injury, infection, or after surgery. These defects can be hernias, where part of the

internal organs protrude through an opening in the abdominal wall, or they can be larger defects

that require reconstruction. Symptoms may include pain, swelling and impaired function of

internal organs. Treatment of abdominal wall defects usually involves surgery to repair the

defect and restore normal function and aesthetics of the abdominal wall, taking into account the

size and location of the defect and the general health condition of the patient. Advanced surgical

skills and precise anatomical knowledge are essential for plastic surgeons to optimize pre- and

postoperative patient outcomes (Mackenzie et al., 2021). Rigorous discipline and medical

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and advanced surgical techniques to achieve optimal aesthetic and functional outcomes, while

tumour may leave a large defect in the abdominal wall. In these cases, the keystone flap

becomes an effective solution for reconstruction (Rao, 2015). The keystone flap is a local tissue

graft technique that utilizes tissue mobilization around the defect area without requiring tissue

transfer from other locations in the body. This technique offers several advantages, including

increased blood flow to the reconstructed area, faster healing, and better aesthetic results. With

a keystone flap, the surgeon can close the defect using local tissue similar to the missing area,

minimizing complications and speeding up the patient's recovery. The keystone flap is included

in reconstructive techniques to treat complex defects, especially on the anterior abdominal wall

and inguinal region (Tanjung & Putri, 2021).

Reconstruction of complex defects of the anterior and inguinal abdomen is challenging

results, making it an ideal choice for reconstructing complex defects of the anterior and inguinal

abdomen (Yoo et al., 2023).

Previous research conducted by Lubis et al. (2020) stated that the transposition flap for

mandibular skin loss reconstruction is the best option for closing the defect because it allows

effective closure by considering the patient's functional units and aesthetic aspects. This

technique allows the transfer of tissue from other areas of the body to the defect area, thus

supporting the restoration of mandibular function and aesthetic appearance. The transposition

flap provides a more natural result and minimizes complications, making it a top choice in

mandibular reconstruction cases.

The Keystone flap as a reconstructive option for anterior and inguinal abdominal defects

Research Methods

This study uses a descriptive method with a retrospective approach. The descriptive

method is a research method that aims to describe or describe certain phenomena or

circumstances as they are (Jayusman & Shavab, 2020). Meanwhile, the retrospective approach

is a research method that involves analyzing data or events that have occurred in the past. In

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then analyze them for patterns, relationships, or certain effects (Fernandes & Indramaya, 2018).

Results and Discussion

Tumor is a medical term used to describe abnormal tissue growth in the body. Tumors

can be malignant (cancerous) or benign (non-cancerous). Malignant tumors can spread to other

parts of the body, while benign tumors tend not to spread and are more limited in their growth

tumor and remove it from the body. This kind of surgery may affect the structure of muscles,

tissues, and other layers that protect the organs around the tumor (Ung et al., 2019). Tumors

come in many different types, one of which is sarcoma. Sarcoma is a type of cancer that

originates in soft tissue or bone. This is different from cancers that originate in solid organs

such as the lungs, breasts or intestines. Sarcomas can arise in different parts of the body,

including muscle, fat, cartilage and other supporting tissues. Sarcomas are often more difficult

to diagnose and treat compared to other cancers due to their rare nature and ability to grow

around vital structures such as blood vessels and nerves. Sarcoma treatment often involves a

combination of surgery, chemotherapy, radiotherapy and targeted therapy, depending on the

location and specific characteristics of the tumor (Rengkung et al., 2020).

in these cases is indispensable to catch and manage these sarcomas effectively (Papanastassiou

et al., 2019).

In the abdominal or inguinal (groin) area, it may mean that tissues supporting spinal

structures, internal organs or the gastrointestinal tract may be disrupted or cut during the

procedure. The result of this manipulation, especially if not performed carefully, can cause

damage to the abdominal wall. This damage can affect the strength and integrity of the

abdominal wall, allowing organs or tissues to protrude out of their normal place, referred to as

a hernia (Putri et al., 2023). To reduce this risk, surgeons usually use proper surgical techniques

and pay attention to important details such as how to close the surgical incision. Postoperative

recovery often also involves treatments to strengthen the abdominal wall and monitoring for

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of damage to the abdominal wall can be minimized (Hu et al., 2023).

normal function of the abdominal wall, prevent hernia recurrence, and reduce the risk of

complications such as infection or long-term discomfort for the patient. Abdominal wall

reconstruction often requires careful handling and skilled surgical techniques to achieve optimal

results in restoring anatomical structures and ensuring long-term postoperative success (Hope

et al., 2023). The importance of covering major damage to the abdominal and inguinal wall

after tumor removal is critical to successful postoperative recovery. Here are some reasons why

this is important:

Preventing Herniation

Damage to the abdominal or inguinal wall can lead to the formation of a hernia, where

internal organs or tissues can protrude through a gap or weakness in the abdominal wall. Hernias

Strengthening Structural Support

The abdominal wall and inguinal canal provide important structural support for organs in

the body, such as the intestines and other organs. When damage occurs to the abdominal wall,

either from surgery or trauma, it can compromise the structural strength and stability needed to

keep the internal organs in their proper position (Saiding et al., 2023). Covering such damage

effectively and robustly, for example through reconstructive techniques such as the Keystone

Flap, can help restore the integrity of the abdominal wall. This not only helps prevent hernias

or other problems that can arise, but also ensures that the internal organs can function optimally

within a healthy and stable body system (Saiding et al., 2023).

Facilitating Healing

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leaks or hernias (Huang et al., 2016). By carefully covering abdominal wall defects and using

also greatly influenced by the patient's quality of life after surgery (Królikowska et al., 2022).

Effective closure of abdominal and inguinal wall damage after tumor removal is essential to

facilitate an optimal healing process. By properly covering such damage, the surgeon can

reduce the risk of complications such as hernias and speed up the patient's recovery. This not

only improves patients' quality of life by minimizing pain and discomfort, but also allows them

to return to normal activities quickly, thus supporting overall recovery and return to productive

daily life (Bitnerr et al., 2019).

To cover the surgical incision of a tumor, especially when there is a need to repair or

strengthen the abdominal wall in a more complex manner, the Keystone Flap is a reconstructive

technique that can be considered. A Keystone flap is a surgical approach that involves

Here are three samples with abdominal defects after surgical procedures at Prof Dr RD

Kandou Hospital from February to May 2020.

Figure 1. samples with abdominal defects after surgical procedures

As such, the keystone flap is an effective surgical technique to cover large defects in the

abdominal and inguinal walls after tumor removal with good results. The technique involves

the use of flexible and strong local tissue to fill the area of damage in a way that minimizes

tension on the sutures and provides good structural support. In this way, the keystone flap not

only helps prevent hernias by strengthening the abdominal wall, but also promotes rapid healing

and facilitates optimal patient recovery, reducing the risk of postoperative complications and

improving their quality of life after the procedure.

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option in reconstructive surgical practice.

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