Skip to main content

Keystone Flap Concepts

  • 156 Accesses

Abstract

This chapter considers how the senior author and pioneer of the keystone perforator island flap (KPIF) applies this method of loco-regional flap to defects of the parotid and peri-auricular regions of the face after cancer resection. The historical evolution of the keystone flap concept is described from Diefennbach’s 1850 V–Y advancement flap concept to the 1995 realisation of the keystone loco-regional flap for multiple soft tissue defects including the head and neck. This local flap is based on the principles of applied anatomy and physiology. It offers a real alternative option to the standard free flap microsurgical reconstruction, which plastic surgeons pioneered, but which have less aesthetic characteristics for the face. There are many advantages to the clinical application of the keystone flap, which are encapsulated in the acronym PACE, painless, aesthetic, complication-free and economic.

Keywords

  • Dermatomal alignment
  • Keystone perforator island flap
  • Parotid and peri-auricular regions
  • Clinical observation
  • PACE acronym

This is a preview of subscription content, access via your institution.

Buying options

Chapter
USD   29.95
Price excludes VAT (USA)
  • DOI: 10.1007/978-3-030-88334-8_9
  • Chapter length: 32 pages
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
eBook
USD   229.00
Price excludes VAT (USA)
  • ISBN: 978-3-030-88334-8
  • Instant PDF download
  • Readable on all devices
  • Own it forever
  • Exclusive offer for individuals only
  • Tax calculation will be finalised during checkout
Hardcover Book
USD   299.99
Price excludes VAT (USA)
Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10
Fig. 11
Fig. 12
Fig. 13
Fig. 14
Fig. 15
Fig. 16
Fig. 17
Fig. 18

References

  1. Behan FC, Wilson JSP. The principles of the angiotome: a system of linked axial pattern flaps. In: Sixth international congress of plastic and reconstructive surgery. Paris, 24–29 August 1975

    Google Scholar 

  2. Klaassen MF, Brown E, Behan FC. Simply local flaps. Springer Nature; 2018. https://doi.org/10.1007/978-3-319-59400-2

  3. Behan FC. The keystone design perforator island flap in reconstructive surgery. ANZ J Surg. 2003;73:112–20.

    CrossRef  Google Scholar 

  4. Behan F, Findlay M, Lo CH. The keystone perforator island flap concept. Sydney: Churchill Livingstone; 2012.

    Google Scholar 

  5. Behan FC, Lo CH, Shayan R. Perforator territory of the keystone flap: use of the dermatomal roadmap. J Plast Reconstr Aesthet Surg. 2009;62:551–3.

    CrossRef  Google Scholar 

  6. Behan F. Surgical tips and skills. Sydney: Churchill Livingstone; 2014.

    Google Scholar 

  7. Behan FC, Rozen WM, Azer S, Gran P. ‘Perineal keystone design perforator island flap’ for perineal and vulval reconstruction. ANZ J Surg. 2012;82:381–2.

    CrossRef  Google Scholar 

  8. Behan F. Evolution of the fascio-cutaneous island flap leading to the keystone flap principle in lower limb reconstruction. ANZ J Surg. 2008;78:116–7.

    CrossRef  Google Scholar 

  9. Behan FC. The fascio-cutaneous island flap: an extension of the angiotome concept. ANZ J Surg. 1992;62:874–86.

    CAS  CrossRef  Google Scholar 

  10. Behan F, Sizeland A, Porcedu S, Somia N, Wilson J. Keystone island flap; an alternative reconstructive option to free flaps in irradiated tissue. ANZ J Surg. 2006;76:407–13.

    CrossRef  Google Scholar 

  11. Behan FC, Paddle A, Rozen WM, et al. Quadriceps keystone island flap for radical inguinal lymphadenectomy; a reliable locoregional island flap for large groin defects. ANZ J Surg. 2013;83:942–7.

    CrossRef  Google Scholar 

  12. Shayan R, Behan FC. Re: the “keystone concept”: time for some science. ANZ J Surg. 2013;83:499–500.

    CrossRef  Google Scholar 

  13. Pelissier P, Santoul M, Pinsolle V, Casoli V, Behan F. The keystone design perforator island flap: part I. Anatomic study. J Plast Reconstr Aesthet Surg. 2007;60:883–7.

    CrossRef  Google Scholar 

  14. Behan F, Sizeland A, Gilmour F, Hui A, Seel M, Lo CH. Use of the keystone island flap for advanced head and neck cancer in the elderly: a principle of amelioration. J Plast Reconstr Aesthet Surg. 2010;63:739–45.

    CrossRef  Google Scholar 

  15. Behan FC, Rozen WM, Tan S. Yin-Yang flaps: the mathematics of two keystone island flaps for reconstructing increasingly large defects. ANZ J Surg. 2011;81:574–5.

    CrossRef  Google Scholar 

  16. Behan FC, Rozen WM, Lo CH, Findlay M. The omega—Ω—variant designs (types A and B) of the keystone perforator island flap. ANZ J Surg. 2011;81:650–2.

    CrossRef  Google Scholar 

  17. Rodriguez-Unda N, Abraham J, Saint-Cyr M. Keystone and perforator flaps in reconstruction. Clin Plast Surg. 2020;47(4):635–48, Elsevier

    CrossRef  Google Scholar 

  18. Potet P, De Bonnecaze G, Chabrillac E, Dupret-Bories A, Vergez S, Chaput B. Closure of radial forearm free flap donor site: a comparative study between keystone flap and skin graft. Head Neck. 2020;42:217–23.

    CrossRef  Google Scholar 

  19. Menick JF. Facial reconstruction with local and distant tissue: the interface of aesthetic and reconstructive surgery. Plast Reconstr Surg. 1998;102:1424–33.

    CAS  CrossRef  Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and Permissions

Copyright information

© 2022 Springer Nature Switzerland AG

About this chapter

Verify currency and authenticity via CrossMark

Cite this chapter

Behan, F.C., Klaassen, M.F., Sizeland, A. (2022). Keystone Flap Concepts. In: Burton, I., Klaassen, M.F. (eds) Atlas of Extreme Facial Cancer. Springer, Cham. https://doi.org/10.1007/978-3-030-88334-8_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-88334-8_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-88333-1

  • Online ISBN: 978-3-030-88334-8

  • eBook Packages: MedicineMedicine (R0)