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The keystone design perforator island flap. Part I: anatomic study
Philippe Pelissier1, Max Santoul, Vincent Pinsolle
1Service de Chirurgie Plastique, Hôpital Pellegrin-Tondu, 33076 Bordeaux, France. philippe.pelissier@chu-bordeaux.fr
Summary
The keystone design perforator island flap demonstrates reliable dual vascularization and static skin paddle behavior under tension. This versatile flap is suitable for widespread application in reconstructive surgery.
Area of Science:
- Plastic Surgery
- Reconstructive Surgery
- Anatomy
Background:
- The keystone design perforator island flap is a trapezoidal flap composed of two V-Y flaps.
- Its viability is attributed to the subcutaneous vascular network and perforators from underlying fascia and muscle.
Purpose of the Study:
- To evaluate the vascularization of the keystone design perforator island flap.
- To assess the behavior of the flap's skin paddle under significant traction.
Main Methods:
- Fourteen flaps were raised on cadavers following defect creation.
- Cutaneous markings analyzed skin paddle behavior during closure and mobilization.
- Vascularization was visualized using colored solution injections before and after flap elevation.
Main Results:
- The superficial vascular network was preserved during dissection.
- Perforators from underlying muscle were consistently identified, confirming dual vascularization.
- The skin paddle remained static in size as surrounding tissues advanced.
Conclusions:
- The keystone design perforator island flap exhibits reliable vascularity and predictable behavior under tension.
- Its design allows for tension distribution across the flap and surrounding tissues.
- The flap's versatility suggests potential for universal application in reconstructive procedures.
