Keystone Flaps

Physiology, Types, and Clinical Applications

Charles Alexander Riccio, Jeremy Chang, Joshua Thomas Henderson, Mahmoud Hassouba, Faisal Ashfaq, Epameinondas Kostopoulos, Petros Konofaos

Research output: Contribution to journalArticle

Abstract

The keystone perforator flap (KPF) was first introduced in 2003 by Behan et al for use in reconstruction after skin cancer excision. Since its initial description, KPF use has been expanded to complex defects of various etiologies and disorders throughout the body. At its most basic, the KPF is a perforator-type flap designed with a 1:1 flap-to-defect width ratio. Keystone perforator flaps are specifically raised on pedicles arising from musculocutaneous or fasciocutaneous perforator vessels. Major advantages of the KPF derive from the maintenance of perforator vascular territories, perforosomes, permitting increased flap viability. In turn, this allows for more aggressive undermining in sites away from perforators when greater skin mobilization is necessary. Furthermore, the KPF is relatively easy to perform leading to shorter operative times and no postoperative monitoring period. There are basically 4 different types of keystone flaps in order of increasing undermining and disturbance of underlying fascia. These different classifications of KPFs may be used in different anatomical locations over the entire body based on skin laxity and defect size/depth. Numerous advancements and modifications have been documented adapting the KPF to specific conditions, including myelomeningoceles, and scrotal and lower eyelid defects. The purpose of this article is to provide an organized review of the KPF with emphasis on different classifications, applications, and limitations as well as an overview of the surgical technique. We have additionally included a discussion on KPF physiology and review of current literature.

Original languageEnglish (US)
Pages (from-to)226-231
Number of pages6
JournalAnnals of plastic surgery
Volume83
Issue number2
DOIs
StatePublished - Aug 1 2019

Fingerprint

Perforator Flap
Meningomyelocele
Skin
Fascia
Skin Neoplasms
Eyelids
Operative Time
Postoperative Period
Blood Vessels
Maintenance

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Riccio, C. A., Chang, J., Henderson, J. T., Hassouba, M., Ashfaq, F., Kostopoulos, E., & Konofaos, P. (2019). Keystone Flaps: Physiology, Types, and Clinical Applications. Annals of plastic surgery, 83(2), 226-231. https://doi.org/10.1097/SAP.0000000000001854

Keystone Flaps : Physiology, Types, and Clinical Applications. / Riccio, Charles Alexander; Chang, Jeremy; Henderson, Joshua Thomas; Hassouba, Mahmoud; Ashfaq, Faisal; Kostopoulos, Epameinondas; Konofaos, Petros.

In: Annals of plastic surgery, Vol. 83, No. 2, 01.08.2019, p. 226-231.

Research output: Contribution to journalArticle

Riccio, CA, Chang, J, Henderson, JT, Hassouba, M, Ashfaq, F, Kostopoulos, E & Konofaos, P 2019, 'Keystone Flaps: Physiology, Types, and Clinical Applications', Annals of plastic surgery, vol. 83, no. 2, pp. 226-231. https://doi.org/10.1097/SAP.0000000000001854
Riccio CA, Chang J, Henderson JT, Hassouba M, Ashfaq F, Kostopoulos E et al. Keystone Flaps: Physiology, Types, and Clinical Applications. Annals of plastic surgery. 2019 Aug 1;83(2):226-231. https://doi.org/10.1097/SAP.0000000000001854
Riccio, Charles Alexander ; Chang, Jeremy ; Henderson, Joshua Thomas ; Hassouba, Mahmoud ; Ashfaq, Faisal ; Kostopoulos, Epameinondas ; Konofaos, Petros. / Keystone Flaps : Physiology, Types, and Clinical Applications. In: Annals of plastic surgery. 2019 ; Vol. 83, No. 2. pp. 226-231.
@article{e102d4840f8043aaaf19eece41dff455,
title = "Keystone Flaps: Physiology, Types, and Clinical Applications",
abstract = "The keystone perforator flap (KPF) was first introduced in 2003 by Behan et al for use in reconstruction after skin cancer excision. Since its initial description, KPF use has been expanded to complex defects of various etiologies and disorders throughout the body. At its most basic, the KPF is a perforator-type flap designed with a 1:1 flap-to-defect width ratio. Keystone perforator flaps are specifically raised on pedicles arising from musculocutaneous or fasciocutaneous perforator vessels. Major advantages of the KPF derive from the maintenance of perforator vascular territories, perforosomes, permitting increased flap viability. In turn, this allows for more aggressive undermining in sites away from perforators when greater skin mobilization is necessary. Furthermore, the KPF is relatively easy to perform leading to shorter operative times and no postoperative monitoring period. There are basically 4 different types of keystone flaps in order of increasing undermining and disturbance of underlying fascia. These different classifications of KPFs may be used in different anatomical locations over the entire body based on skin laxity and defect size/depth. Numerous advancements and modifications have been documented adapting the KPF to specific conditions, including myelomeningoceles, and scrotal and lower eyelid defects. The purpose of this article is to provide an organized review of the KPF with emphasis on different classifications, applications, and limitations as well as an overview of the surgical technique. We have additionally included a discussion on KPF physiology and review of current literature.",
author = "Riccio, {Charles Alexander} and Jeremy Chang and Henderson, {Joshua Thomas} and Mahmoud Hassouba and Faisal Ashfaq and Epameinondas Kostopoulos and Petros Konofaos",
year = "2019",
month = "8",
day = "1",
doi = "10.1097/SAP.0000000000001854",
language = "English (US)",
volume = "83",
pages = "226--231",
journal = "Annals of Plastic Surgery",
issn = "0148-7043",
publisher = "Lippincott Williams and Wilkins",
number = "2",

}

TY - JOUR

T1 - Keystone Flaps

T2 - Physiology, Types, and Clinical Applications

AU - Riccio, Charles Alexander

AU - Chang, Jeremy

AU - Henderson, Joshua Thomas

AU - Hassouba, Mahmoud

AU - Ashfaq, Faisal

AU - Kostopoulos, Epameinondas

AU - Konofaos, Petros

PY - 2019/8/1

Y1 - 2019/8/1

N2 - The keystone perforator flap (KPF) was first introduced in 2003 by Behan et al for use in reconstruction after skin cancer excision. Since its initial description, KPF use has been expanded to complex defects of various etiologies and disorders throughout the body. At its most basic, the KPF is a perforator-type flap designed with a 1:1 flap-to-defect width ratio. Keystone perforator flaps are specifically raised on pedicles arising from musculocutaneous or fasciocutaneous perforator vessels. Major advantages of the KPF derive from the maintenance of perforator vascular territories, perforosomes, permitting increased flap viability. In turn, this allows for more aggressive undermining in sites away from perforators when greater skin mobilization is necessary. Furthermore, the KPF is relatively easy to perform leading to shorter operative times and no postoperative monitoring period. There are basically 4 different types of keystone flaps in order of increasing undermining and disturbance of underlying fascia. These different classifications of KPFs may be used in different anatomical locations over the entire body based on skin laxity and defect size/depth. Numerous advancements and modifications have been documented adapting the KPF to specific conditions, including myelomeningoceles, and scrotal and lower eyelid defects. The purpose of this article is to provide an organized review of the KPF with emphasis on different classifications, applications, and limitations as well as an overview of the surgical technique. We have additionally included a discussion on KPF physiology and review of current literature.

AB - The keystone perforator flap (KPF) was first introduced in 2003 by Behan et al for use in reconstruction after skin cancer excision. Since its initial description, KPF use has been expanded to complex defects of various etiologies and disorders throughout the body. At its most basic, the KPF is a perforator-type flap designed with a 1:1 flap-to-defect width ratio. Keystone perforator flaps are specifically raised on pedicles arising from musculocutaneous or fasciocutaneous perforator vessels. Major advantages of the KPF derive from the maintenance of perforator vascular territories, perforosomes, permitting increased flap viability. In turn, this allows for more aggressive undermining in sites away from perforators when greater skin mobilization is necessary. Furthermore, the KPF is relatively easy to perform leading to shorter operative times and no postoperative monitoring period. There are basically 4 different types of keystone flaps in order of increasing undermining and disturbance of underlying fascia. These different classifications of KPFs may be used in different anatomical locations over the entire body based on skin laxity and defect size/depth. Numerous advancements and modifications have been documented adapting the KPF to specific conditions, including myelomeningoceles, and scrotal and lower eyelid defects. The purpose of this article is to provide an organized review of the KPF with emphasis on different classifications, applications, and limitations as well as an overview of the surgical technique. We have additionally included a discussion on KPF physiology and review of current literature.

UR - http://www.scopus.com/inward/record.url?scp=85069502285&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85069502285&partnerID=8YFLogxK

U2 - 10.1097/SAP.0000000000001854

DO - 10.1097/SAP.0000000000001854

M3 - Article

VL - 83

SP - 226

EP - 231

JO - Annals of Plastic Surgery

JF - Annals of Plastic Surgery

SN - 0148-7043

IS - 2

ER -