Jul 28, 20 the keystone perforator island flap, concept. These flaps are based on the concept of angiotome, a section of skin, and underlying tissue that can be islanded on its axial perforator vessels while the periphery of this. They type i keystone flap is a skin island based on subcutaneous perforators. Read pdf the keystone island flap concept in reconstructive surgerythe keystone perforator island flap concept 1st edition 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. Oct 01, 2016 the keystone perforator flap concept a useful tool in the armamentarium of plastic surgery the keystone perforator flap concept a useful tool in the armamentarium of plastic surgery yordanov, y krupev, m shef, a nikolova, a. The use of keystone flaps in periarticular wound closure. The keystone design perforator island flap was first described by behan in 2003 1 with an experience of 300 successful cases. The keystonedesign perforatorbased flap for leg defects. Using the keystone design perforator island flap in large myelomeningocele. The concepts of propeller, perforator, keystone, and other local flaps and their. The keystone perforator island flap elsevier australia. Recently, the keystonedesign perforator island flap kdpif, a type of localised flap, has gained preference for.
The other authors have no financial interest to declare in relation to the content of this article. Nov 17, 2017 pedicle perforator flaps and keystone perforator island flaps are additional tools for reconstructive surgeons. A prospective cohort study was conducted from october 2014. Opportunities are available for basic science research in the nih funded wound healing research lab. We have coined the term keystone design perforator island flap kdpif because of its. However, this surgical concept still remains unpopular in the bulgarian practice and science of. Nikolova4 department of plastic reconstructive and aesthetic surgery. Keystone perforator island flaps are fascial lined, supporting vascular integrity. 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. The keystone perforator flap for tensionfree closure of defects in.
Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and withstand. The keystone island perforator flap is a relatively new. The keystone perforator island flap was initially described by behan 3 as a trapezoidal shaped flap which. The keystone perforator island flap keystone flap, is a type a fasciocutaneous advancement flap, consisting of two v to y advancement flaps. The keystone perforator flap concept a useful tool in the. The keystone perforator flap concept a useful tool in the armamentarium of plastic surgery the keystone perforator flap concept a useful tool in the armamentarium of plastic surgery yordanov, y krupev, m shef, a nikolova, a. However, as this idea emerged and was blended with the perforator flap concept, its application expanded to include coverage of wounds in the lower extremity. Principles of perforator anatomy, design modifications. Sep 30, 2012 the keystone flap is being promoted as an advance in oncological surgical reconstruction. Report the keystone perforator island flap concept behan 9780729539715 samplechapter please fill this form, we will try to respond as soon as possible. Unlimited viewing of the articlechapter pdf and any associated supplements and figures. C postoperative clinical photograph after 1 month of followup. Nowadays plenty of reconstructive options exists in the armamentarium of the specialty.
The keystone perforator island flap concept book, 2012. Loh mbbs, pgdipsurganat department of plastic and reconstructive surgery, dandenong hospital, southern health, dandenong, victoria, australia. Its name refers to the curved, wedgeshaped block at the apex of roman archways. However, this surgical concept still remains unpopular in the bulgarian practice and science of plastic surgery. Wound closure with this island flap involves two vy advancements toward the center and along the long axis of the island, at right angles to the line of maximum tension when the wound is closed. 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. Nikolova4 department of plastic reconstructive and aesthetic. Advances in understanding of vascular anatomy, the dynamic nature of perforator perfusion, inter perforator flow and the hotspot principle have led to reconstructive techniques that allow innovative autologous tissue transfer while limiting donor site morbidity. The keystone design perforator island flap in reconstructive surgery. Evolving concepts of keystone perforator island flaps kpif.
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. B after excision and release of the contracture then followed by elevation of keystone flap. It retains the unique advantages of both the perforator island flap concept as well as the keystonedesign philosophy. The keystone perforator island flap concept 1st edition. This surgical method can be a valuable supplement to the reconstructive repertoire in the field of reparative surgery. The concept of the fasciocutaneous island flap fcif has been established as a result of clinical experience in which over 180 cases have been compiled. The keystone flap is being promoted as an advance in oncological surgical reconstruction.
The first ever international course on perforator flaps icpf was organized in gent, belgium, 20 years ago in 1997, when perforator flap surgery was still in its pioneering phase. This study aims to modify the keystonedesign flaps for leg defects. A keystone solution for major head and neck reconstructions. The keystone perforator island flap concept 1st edition elsevier. The keystone island flap concept in reconstructive surgery. Apr 17, 2020 report the keystone perforator island flap concept behan 9780729539715 samplechapter please fill this form, we will try to respond as soon as possible. Popliteal keystone island flap for management of contracture. The result of wounds closure by local keystone perforator flap, 16 days after surgery, the skin and function of leg are completely restored. Keystone and pedicle perforator flaps in reconstructive. Excision of skin lentigo maligna of the middle third of the neck and reconstruction with a keystone flap from the posterior skin surface of the neck. Relaxed skin tension lineoriented keystonedesigned. 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. Two shrapnel wound defects on the right leg and local keystone perforator flap design, with size 6x31 cm.
C immediate postoperative view after closure of the soft tissue defect. The flap becomes a template of the excisional defect fig. A keystone design flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. The keystone perforator island flap concept 9780729539715. According to this author, the shape of the flap seems to lock into the defect as a keystone locks a roman arch through gravity. It is implied that the longaxis advancements enable closure by relaxing the entire flap of skin, allowing. The keystone flapa case series demonstrating practical. It retains the unique advantages of both the perforator island flap concept as well as the keystone design philosophy.
The physiology and geometry of the keystone flap kf are the main factors that support its development. This idea and the geometry of its design support the development of the keystone flap kf. The use of the keystone island flap for specific surgical specialities, including head and neck, melanoma, trauma including compound fractures of the lower limb and even irradiated tissue is also addressed. Flap, keystone, leg defect, lower extremity reconstruction, perforator island flap access this article online quick response code. Evolution of local perforator flaps in lower extremity.
This study reports our experience using the kf and proposes the concept of pedicular area. Oct 11, 2019 recently, the keystone design perforator island flap kdpif, a type of localised flap, has gained preference for reconstruction of various sites 10. 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. Using the keystone design perforator island flap in large. Pdf the keystone perforator island flap concept behan. 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. Perforator flap surgery was described as extravagant and exceptional in those days but it has now become the mainstream reconstructive technique for restoring. The keystone perforator flap concept a useful tool in. Extended experience and modifications in the design and. Keystone island perforator flap behan fc, findlay m, ch lo, elsevier 2012.
In the 1970s, behan and wilson 1 coined the concept of angiotome, which refers to the 3dimensional tissue unit supplied by a dynamic vascular network. Clearly presented and easy to follow, this excellent australian publication features an accompanying dvd, further exploring this surgical method. The technique as well as the possibilities of raising such flaps over various areas of the leg is outlined. Surgical management of giant genital condyloma acuminata. Pdf the keystone perforator flap concept a useful tool in the. Based on the tokyo consensus 24, a propeller flap is now defined as an axial flap that reaches the recipient site through axial rotation.
The keystone perforator island flaps is a sophisticated and relatively easy option for defect closure. Recently, the keystonedesign perforator island flap kdpif, a type of localised flap, has gained preference for reconstruction of various sites 10. A keystonedesign flap, in which perforators are identified and dissected, is described specifically for elliptical defects overlying the tibia. Pdf the keystone approach download full pdf book download. The keystone perforator island flap concept, 1e 1st edition pdf. 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. Owing to the mobile nature of joints, the optimal periarticular reconstructive option should possess the ability to provide adequate tissue coverage and. Keystonedesigned perforator island flaps for the coverage of. Skin cancer excision around joints presents a number of reconstructive challenges. The flap is advanced into the area that requires cover, with. Because the donor vessels have traversed muscle before reaching the fascia, a longer vascular pedicle can be dissected.
Illustrates the use of a type iia keystone flap to reconstruct a 4. Lanni, ma, van kouwenberg, e, yan, a, rezak, km, patel, a. One hundred twelve flaps were performed in 89 patients 45 men and 44 women with an average age of 64 years range, 389 years. Perforator flap definition of perforator flap by medical. The keystone island flap was described in 20031, 2 and we have routinely used it in clinical practice for approximately five years. In the 1970s, behan and wilson 1 introduced the angiotome concept that culminated in the keystone island flap design. Keystone flap was marked where x mark indicates site of perforator as detected by doppler us. The bezier flap is an island perforator flap which is based on the french curve design of opposing ellipses fig. The keystone perforator island flap concept, 1e 1st edition pdf by felix behan frcs fracs author, michael findlay mbbs phd 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. 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. Keystonedesign perforator island flaps for the management of. 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. Her basic science research is based in the center for regenerative and cancer cell biology.
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