Keystone and Pedicle Perforator Flaps in Reconstructive Surgery: New Modifications and Applications

Pedicle perforator flaps and keystone perforator island flaps are additional tools for reconstructive surgeons. Advances in understanding of vascular anatomy, the dynamic nature of perforator perfusion, inter-perforator flow and the hot-spot principle have led to reconstructive techniques that allow innovative autologous tissue transfer while limiting donor site morbidity. Further modifications of the pedicle perforator flap have led to a multitude of freestyle pedicle perforator flap options, as well as freestyle free flaps for soft tissue reconstruction. Modifications in the keystone perforator island flap have increased the degrees of freedom for soft tissue coverage of large defects, with reliable and aesthetically pleasing results.