Summary
Background
This curvilinear- and trapezoidal-shaped flap essentially consists of two conjoined
V–Y flaps end to side. The vascular supply is supported by the subcutaneous vascular
network and is dependent on fascial and muscular perforators. A review of 15 clinical
cases was performed to assess the reliability and versatility of the flap.
Methods
Twelve keystone flaps were performed following excision of skin tumours or post-traumatic
defects in various locations, from the head and neck region, the trunk and the limbs.
Results
No flap necrosis, even partial, was observed regardless of the site and the type of
keystone used. Patients were almost pain free in the postoperative course. The aesthetic
results are quite satisfactory, as the flap is aligned locally without evidence of
the ‘pincushioning’ appearance sometimes seen around island reconstructions.
Discussion
Elevation of the flap seems to evenly distribute the tensional forces without undermining.
The flap is particularly useful in the repair of defects following skin cancer removal.
Bulk is not a problem and good skin cover is achieved.
Conclusion
The presence of perforators and subcutaneous network distributed throughout the body
create an environment which makes this flap universally applicable and extremely reliable.
Keywords
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References
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- The keystone design perforator island flap. Part I: anatomic study.J Plast Reconstr Aesthet Surg. 2007; 60: 883-887
- Neurocutaneous axial island flaps in the forearm: anatomical, experimental and preliminary clinical results.Br J Plast Surg. 1993; 46: 489-496
- The neurocutaneous flap based on the dorsal branches of the ulnar artery and nerve: a new flap for extensive reconstruction of the hand.Plast Reconstr Surg. 1998; 101: 1537-1543
- The neurovascular territories of the skin and muscles: anatomic study and clinical implications.Plast Reconstr Surg. 1994; 94: 1-36
- Fascial feeder and perforator-based V Y advancement flaps in the reconstruction of lower limb defects.Br J Plast Surg. 2000; 53: 679-689
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Article info
Publication history
Published online: May 11, 2007
Accepted:
March 20,
2007
Received:
October 30,
2006
Identification
Copyright
© 2007 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Inc. All rights reserved.
ScienceDirect
Access this article on ScienceDirectLinked Article
- The keystone design perforator island flap. Part I: Anatomic studyJournal of Plastic, Reconstructive & Aesthetic SurgeryVol. 60Issue 8
- PreviewThe keystone design perforator island flap has been described as a curvilinear shaped trapezoidal design flap that is essentially two V–Y flaps end-to-side. Viability of the flap is thought to be supported by the subcutaneous vascular network and fascial and muscular perforators. The aim of this study was to assess the vascularisation of this flap and the behaviour of the skin paddle when submitted to important traction forces.
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