The croissant like keystone perforator island flap ckpif and the bridge principle in medial canthus reconstruction. Thermal imaging facilitates design of a keystone perforator. The keystone design perforator island flap was first described by behan in 2003 1 with an experience of 300 successful cases. The curvilinear shape of the flap fits well into body contours. The keystone island perforator flap is a relatively new. Data describing the primary tumor, surgical management, and outcome were collected prospectively for consecutive keystone flap cases. Aug 08, 2019 lower extremity defects are challenging to reconstruct. Felix behan,michael findlay,cheng hean lo 201201 medical. This article evaluates the shortterm and longterm outcomes of these. Cheng hean lo this book is a guide to the development, design and surgical application of the effective surgical technique known as the keystone island flap. The croissant like keystone perforator island flap ckpif. Description download the keystone perforator island flap concept behan 9780729539715 samplechapter. Marking of the contracture band over medial aspect of popliteal fossa as elliptical excision.
These findings confirm that the keystone perforator island flap procedure can be effective for immediate defect reconstruction after wide local excision of advanced hidradenitis suppurativa of the axillary, inguinal and sacrococcygeal regions and provides excellent aesthetic results. If there is limited skin island availability as donor area, the keystone flap width can be made narrower than the excisional vertical diameter. Keystone flap was marked where x mark indicates site of perforator as detected by doppler us. Keystone design perforator island flap kdpif to reconstruct soft tissue defects and avoid complex reconstruction. Reconstruction after wide excision of primary cutaneous.
The use of keystone island flaps for specific surgical specialities, including head and neck, melanoma, trauma including compound fractures of the lower limb and even irradiated tissue is also addressed. Method of surgical closure of extensive mine shrapnel and gunshot wounds by perforator keystone flaps, improves the efficiency of reconstructive interventions in patients with war injuries. Keystonedesigned perforator island flaps for the coverage. Reconstruction of pretibial skin and softtissue defects remains a challenge because this area has less underlying tissues and limited tissue mobility. Purchase the keystone perforator island flap concept 1st edition. Ab we present a series of three infants who underwent keystone design perforator island flap kdpif closure for myelomeningocele in a paediatric neurosurgical centre in australia. In the 1970s, behan and wilson 1 introduced the angiotome concept that culminated in the keystone island flap design. It retains the unique advantages of both the perforator island flap concept as well as the keystone design philosophy. The keystone perforator island flap concept 9780729539715. The keystone perforator flap for tensionfree closure of defects in. Keystone perforator island flap elsevier australia. Based on fasciocutaneous perforators, the keystone island flap offers. The keystone perforator island flap in nasal reconstruction. The keystone perforator island flap keystone flap, is a type a fasciocutaneous advancement flap, consisting of two v to y advancement flaps.
The keystone flap minimizes the need for skin grafting in the majority of cases and produces excellent aesthetic. The keystone perforator island flap concept 1st edition elsevier. An application of keystone perforator island flap for. Clinical cases of keystone island perforator flaps michel saintcyr, m. Skin cancer excision around joints presents a number of reconstructive challenges. The books expert authors discuss the design elements underpinning the keystone island flap, examine specific defects in various body regions and show how keystone island flaps have been used successfully.
Pedicle perforator flaps and keystone perforator island flaps are additional tools for reconstructive surgeons. The technique has to be simple, easily reproducible and performed. For these cases, the traditional approach was to use a split skin graft however this leaves the patient with a deep contour defect and color mismatch. The keystone flap minimizes the need for skin grafting in the majority of cases and produces excellent aesthetic results. Oct 11, 2019 keystone design perforator island flap kdpif reconstruction after complete excision of the ruptured epidermoid cyst ec with cellulitis in a 60yearold man. The keystone island flap concept in reconstructive surgery. Mar 14, 2003 we have coined the term keystone design perforator island flap kdpif because of its curvilinear shaped trapezoidal design borrowed from architectural terminology. Read the keystone perforator flap concept a useful tool in the armamentarium of plastic surgery, acta medica bulgarica on deepdyve, the largest online rental service for scholarly research with thousands of academic publications available at your fingertips. The keystone perforator island flap concept book, 2012. This is a case series of 11 patients with symptomatic latestage breast cancers indicated for neoadjuvant chemotherapy and subsequent mastectomy at dharmais cancer. The importance of blunt dissection is emphasized in raising these perforator island flaps as it preserves the vascular integrity of the musculocutaneous and fasciocutaneous perforators together with venous and neural connections. According to this author, the shape of the flap seems to lock into the defect as a keystone locks a roman arch through gravity. The first publication of this technique, titled the keystone design perforator island flap, occurred in the anz journal of surgery in 2003. Clinical cases of keystone island perforator flaps.
The keystone design perforator island flap in reconstructive surgery free download as pdf file. The keystone perforator island flap concept is the definitive guide to the development, design and surgical application of the effective surgical technique known as the keystone island flap. What started as a small meeting among friends, has grown into a major international forum where colleagues share their new ideas in the field of perforator. The fortune cookie flap for aesthetic reconstruction after. Closure of wounds after excision of skin cancers on the leg provide a challenge, especially after wide excision of melanoma. The keystone flapa case series demonstrating practical. They type i keystone flap is a skin island based on subcutaneous perforators. Nowadays plenty of reconstructive options exists in the armamentarium of the specialty. Along with its companion dvd, it highlights the keystone flap method as a valuable supplement to the reconstructive repertoire in the field of reparative surgery and a simple solution to many reconstructive problems. Download file pdf the keystone island flap concept in reconstructive surgery keystone flap author. Keystone and pedicle perforator flaps in reconstructive. Lower extremity defects are challenging to reconstruct. Pdf the keystone approach download full pdf book download. The flap included several source artery for cutaneous angiosome.
Its name refers to the curved, wedgeshaped block at the apex of roman archways. Warren noel, iad nseir a keystone island perforator flap is typically used for reconstruction of an oncologic resection defect of sarcomas and skin cancers in the extremities, trunk, and. The core principle in the management of primary cutaneous melanoma is wide surgical excision, but occasionally a balance is needed between adequately resecting a potentially curable lesion and minimising the functional deficit in manual dexterity or ambulation for the patient. Principles of perforator anatomy, design modifications. During the last 4 years, the keystonedesign fasciocutaneous island flap has become the principal form of reconstruction in our unit for primary melanoma defects of the leg distal to the knee where primary closure is not possible. Keystone perforator island flap kpif is a local advancement flap based on multiple perforators which can be a reliable reconstructive method to close an extensive defect. B after excision and release of the contracture then followed by elevation of keystone flap. At monash health, victoria, we have used the keystone perforator island flaps to reconstruct lumbosacral myelomeningocele defects on 5 newborns between january 2008 and january 2014. Keystonedesigned perforator island flaps for the coverage of. The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined.
A keystone solution for major head and neck reconstructions. The kdpif is a curvilinear shaped trapezoidal design flap. Keystonedesign perforator island flaps for the management. We therefore applied the technique of kdpif reconstruction to the. The keystone perforator island flap concept, 1e 1st edition pdf. The keystone design perforator island flap in reconstructive surgery. Nov 29, 2017 the keystone perforator island flap keystone flap, is a type a fasciocutaneous advancement flap, consisting of two v to y advancement flaps. Using the keystone design perforator island flap in large.
We have coined the term keystone design perforator island flap kdpif because of its curvilinear shaped trapezoidal design borrowed from architectural terminology. Keystone perforator island flap for postmastectomy defect. Keystonedesign perforator island flaps for the management of. Nov 17, 2017 freestyle ppf allows greater degrees of freedom in operative planning, because flaps can be based on any dominant perforator. Keystone perforator island flap is a multiperforator advancement flap based on musculocutaneous or fasciocutaneous perforators with high rates of flap survival, decreased donor site morbidity and pain, and quick. The keystone design perforator island flap in reconstructive. Pdf the keystone perforator flap concept a useful tool in. Based on fasciocutaneous perforators, the keystone island flap offers both the robust vascularity of perforator flaps and. Keystone flap reconstruction of primary melanoma excision.
An application of keystone perforator island flap for closure. Frontiers the use of keystone flaps in periarticular. It is essentially elliptical in shape with its long axis adjacent to the long axis of the defect. Mar 14, 2003 the keystone flap minimizes the need for skin grafting in the majority of cases and produces excellent aesthetic results. The keystone approach available for download and read online in other formats.
The keystone flap width is the same as excisional vertical diameter when possible. Popliteal keystone island flap for management of contracture. Surgical management of hidradenitis suppurativa with keystone. Pdf the keystone perforator flap concept a useful tool. Keystone design perforator island flaps for the management of complicated epidermoid cysts on the back. The keystone perforator island flap keystone flap, is a type a fasciocutaneous advancement flap, consisting of two v to y advancement flap. A keystone design flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. The keystonedesign perforatorbased flap for leg defects. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring defects throughout the body. The keystone perforator island flap concept, 1e 1st. The keystone perforator island flap elsevier australia. Type i direct closure, type ii with or without grafting, type iii employs a double island flap technique, and type iv involves rotation and advancement with or without grafting.
Surgical management of hidradenitis suppurativa with. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and withstand. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and. The keystone perforator island flap proves useful in difficult cases. We describe, for the first time, a case of inflammatory panurethral stricture disease complicated by fournier gangrene with extensive penile, scrotal, and perineal skin deficit managed with a perineal urethrostomy, with the help of keystone design perforator island flaps with successful outcome. Croissant like keystone perforator island flap ckpif and the bridge principle in medial canthus reconstruction. In this small series, we have demonstrated the use of keystone design perforator island flap closure as an alternative for larger and more complex lesions. The keystone island perforator flap is a relatively new conception which consists of taking skin and superficial fascia in a keystone pattern adjacent to the defect that needs to be covered.
Keystonedesign perforator island flap kdpif reconstruction after complete excision of the ruptured epidermoid cyst ec with cellulitis in a 60yearold man. A surgical technique for closing skin defects following skin cancer particularly melanoma removal. Advances in understanding of vascular anatomy, the dynamic nature of perforator perfusion, interperforator flow and the hotspot principle have led to reconstructive techniques that allow innovative autologous tissue transfer while limiting donor site morbidity. The flap is based on randomly located vascular perforators. It retains the unique advantages of both the perforator island flap concept as well as the keystonedesign philosophy. Pdf the keystone perforator flap concept a useful tool in the. Traditionally, a handheld doppler is used to confirm perforator vessels within the flap but has disadvantages including low. The keystone design perforator island flap is a trapezoidalshaped random perforator island flap with many advantages over primary closure, skin grafting, and other local flaps for soft tissue reconstruction commonly encountered with cancer excisions. Keystone design perforator island flap for closure of. A secondary but nonetheless increasingly important consideration in this location is the potential cosmetic deformity. Recently, the keystonedesign perforator island flap kdpif, a type of. The keystone perforator island flap, first described by behan, is based on randomly located vascular perforators and is used as a locoregional flap option for. Illustrates the use of a type iia keystone flap to reconstruct a 4. Pdf the keystone perforator island flap concept behan.
The keystone perforator island flap concept is an authoritative keystone flap textbook. Evolving concepts of keystone perforator island flaps kpif. Frontiers the use of keystone flaps in periarticular wound. This article evaluates the shortterm and longterm outcomes of these patients who were followed up for 10 to 66 months. The keystone perforator island flaps is a sophisticated and relatively easy option for defect closure. Warren noel, iad nseir a keystone island perforator flap is typically used for reconstruction of an oncologic resection. The keystone perforator island flap, first described by behan, is based on randomly located vascular perforators and is used as a locoregional flap option for almost every part of the body. The use of the keystone island flap for specific surgical specialities, including head and neck.
The keystone design perforator island flap has been described as a curvilinear shaped trapezoidal design flap that is essentially two vy flaps endtoside. Clearly presented and easy to follow, this excellent australian publication features an accompanying dvd, further exploring this surgical method. The csm keystonedesign perforator island flap is a novel and versatile flap, which can be used in a range of advanced cheek and parotidectomy defects, and may enable improved surgical. A keystonedesign flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. Based on fasciocutaneous perforators, the keystone island flap offers both the robust vascularity of perforator flaps and relative ease and speed of local tissue rearrangement.
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