‘Perineal keystone design perforator island flap’ for perineal and vulval reconstruction

Evolving Concepts of Keystone Perforator Island Flaps (KPIF): Principles of Perforator Anatomy, Design Modifications, and Extended Clinical Applications

“…Even for large complex wound reconstructions, the flaps can be easily harvested in 20 to 30 minutes, depending on surgical experience, the need for fascial incision, and the demands of the reconstruction. Vascular anatomy and microsurgical principles demonstrated through numerous commendable contributions to the literature, 3,4,[12][13][14][15] and refinements in clinical practice, have provided fundamental principles relevant to the keystone flap design and its modifications. 7 Milton had revealed that survival of the integument was dependent on the inclusion of a large vessel for the survivability of islanded flaps and observations that "an island is safer than a peninsula."…”

“…When designed over mobile muscle bellies (e.g., in the proximal thigh), release of the deep fascia even on one side can provide significant advancement subject to local tissue quality. 23 The keystone flap has demonstrated a growing diversity of clinical applications, 7-9 including coverage of large defects of the trunk, 10 limb, 13,14,21,26 groin, 23 perineum, 15 myelomeningocele, 27 and head and neck. 28 Previous modifications include a "yin yang" reconstruction, 29 including partial undermining and interdigitation of bilateral keystone flaps, 7 and the "omega variant," where both limbs of a single keystone are folded into a horseshoe shape.…”

Keystone flaps in urethroplasty: Reconstruction in a complex case of panurethral stricture disease

“…The KDPIF technique has been used for various perineal, vulval, and other reconstructions. Defects as large as 20 cm have been covered at various sites with an overall success rate of 96.36% 234. The other treatment options in this case could have been staged urethroplasty with split skin grafting for lateral skin defects or a single-stage urethral reconstruction with radial forearm skin-free flap.…”

Keystone Flap: Overcoming Paradigms

“…Changes in the KF original design have been described in different studies. 28,29 In this series, the trapezoidal design was always the first step. Based on this, the axes and edges were adapted to the donor area, maintaining, as much as possible, the major axis of the flap parallel to the defect and, at least in 1 end, the V-Y closure design to optimize the advance (Fig.…”