The modified bipedicled flap for reconstruction of oncological skin defects of the trunk and extremities

Abstract Background/Aims Oncological skin defects of the extremities and trunk can be challenging. Our modified bipedicled flap utilises the principle of the bipedicled advancement flap but allows for direct closure of the donor site (as opposed to skin grafting). Unlike the original description of the keystone flap it does not rely on the preservation of perforators and is random pattern, making it extremely versatile. We aimed to assess the outcomes for patients reconstructed using the modified bipedicled flap technique including oncological safety and complications. Methods Consecutive patients were retrospectively identified from July 2011 to January 2019 using operative records. Demographics, operative details, oncological data, and complications were recorded from patient records and the institution's internal electronic patient records system. No cases having a modified bipedicled flap were excluded from this study. Results 100 flaps in 98 patients were included. Mean defect dimensions were 61.7mm by 33.1mm. Median length of stay was 1 day, time to discharge from dressing clinic was 15 days, and length of follow up was 6.0 years. Eight patients required oral antibiotics for suspected localised wound infection, and six patients had minor wound healing problems. There were no cases of flap failure, partial flap loss, returns to theatre for flap-related complications, or local disease recurrence. Conclusions To our knowledge this is the largest series of bipedicled flaps published to date. Our technique is easy to execute, versatile, and allows for direct closure of the secondary defect with excellent cosmetic results. It is oncologically safe, with a low incidence of complications. We commend it for use in the reconstruction of oncological skin defects of the trunk and extremities.