A keystone solution for major head and neck reconstructions

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Felix Behan


reconstructive surgical techniques, neck, head, perforator flap, neoplasms


This feature lists a range of cases, demonstrated by supplementary video discussion, that explain the refinements of the keystone perforator island flap (KPIF) technique applied to specific sites of the head and neck, with a focus on the elderly.

When the P A C E acronym is applied (pain-free, aesthetic outcome, minimal complications, economical) the KPIF technique is a respectable alternative to microvascular surgery, particularly in the elderly, with minimal returns to theatre for vascular impedance problems which are not infrequent in microvascular reconstructions.


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1. Behan FC. The keystone design perforator island flap in reconstructive surgery. Aust NZ J Surg. 2003;73:112–120. https://doi.org/10.1046/j.1445-2197.2003.02638.x
2. Behan FC, Findlay MW and Lo CH. The keystone perforator island flap concept. Chatswood, Sydney: Elsevier Australia, 2012.
3. Gillies H and Millard DR. The principles and art of plastic surgery. London: Butterworth and Co. 1957.
4. Mohan AT, Rammos CK, Akhavan AA, Martinez J, Wu PS, Moran SL, Sim FH, Behan F, Mardini S, Saint-Cyr M. Evolving concepts of keystone perforator island flaps (KPIF): principles of perforator anatomy, design modifications, and extended clinical applications. Plast Reconstr Surg. June 2016;137(6):1909–920. https://doi.org/10.1097/PRS.0000000000002228PMid:26895582