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Keystone Flap Concepts

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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.


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

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

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