Type 1 Keystone Flap versus Simple Primary Closure for wound closure - A Prospective Randomised Controlled Trial

Surgical defeects that are predicted to be difficult to close may be considered for type one ketstone closure. The theoretical advantage of this method is that the release of the longitudinal tension in the wound allows greater stretch along the transverse axis. There is no reliable evidence in the literature to prove that this is the case in human models, indeed in our small study the increase in transverse stretch enabled by longitudinal release was less than 1mm. With this in mind the advantage of a keystone flap over other wound closure techniques is unclear. We aim to compare the keystone flap with simple primary wound closure, with primary outcome measured as wound healing, using the ASEPSIS wound score. The type one keystone flap was first described by Behan in 2003, for use in "suitable defects over most areas of the body up to 2cm in width". Patients will be recruited into the study based upon this selction criteria and then randomised to keystone flap or primary closure. Short and longterm follow up centered around the ASEPSIS wound score will be used to compare wound healing in the two groups.