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Keystone Island Flap Reconstruction of Parotid Defects

Behan, Felix C. F.R.A.C.S.; Lo, Cheng H. M.B.B.S.; Sizeland, Andrew Ph.D., F.R.A.C.S.; Pham, Toan M.B.B.S.; Findlay, Michael F.R.A.C.S., Ph.D.

Plastic and Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 36e–41e
doi: 10.1097/PRS.0b013e3182547f55
Reconstructive: Head and Neck: Original Articles

Background: Skin cancers of the face and scalp have a propensity to metastasize to the parotid group of lymph nodes. The resection of these secondary tumors and other primary tumors in the parotid region often results in defects requiring flap reconstruction. Pectoralis major flaps are reliable and free flaps are arguably the criterion standard. However, we have found keystone island flaps to be a simple and robust alternative, with low donor-site and patient morbidity. The aim of this article is to share our surgical technique, experience, and outcomes of reconstructing parotid defects with keystone island flaps.

Methods: The authors retrospectively reviewed 62 patients who had 63 parotid defect reconstructions at a single institution from 2004 to 2009 (5-year period).

Results: The diseases involved were squamous cell carcinoma (52 cases), melanoma (five cases), basal cell carcinoma (four cases), and others (two cases). Nine patients presented with a previous history of radiotherapy and 33 patients required adjuvant radiotherapy. Seven patients (11 percent) suffered postoperative complications necessitating a return to the operating room.

Conclusions: Keystone island perforator-based flaps present an alternative to free tissue transfer. From the series presented, it can be seen that reliable and reproducible results are achievable.


Parkville, Footscray, and East Melbourne, Victoria, Australia

From the Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital; the Department of Plastic and Reconstructive Surgery, Western General Hospital; and the Department of Surgical Oncology, Peter MacCallum Cancer Institute.

Received for publication October 6, 2010; accepted March 10, 2011.

Presented at the 79th Annual Scientific Congress of the Royal Australasian College of Surgeons, in Perth, Western Australia, Australia, May 4 through 7, 2010.

Disclosure: The authors have no financial interest to declare in relation to the content of this article. No outside funding was received.

Cheng H. Lo, M.B.B.S.; Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Grattan Street, Parkville, Victoria 3050, Australia,

©2012American Society of Plastic Surgeons