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The Keystone Perforator Island Flap in Head and Neck Reconstruction: Indications and Outcomes from 200 Flaps

Findlay, Michael W. MBBS, PhD; Sinha, Shiba MBBS, BSc; Rotman, Anthony MBBS; Ting, Jeannette MBBS; Fairbank, Sian MBBS; Wu, Terry MBBS; Donahoe, Simon MBBS; Wilson, Jeremy MBBS; Behan, Felix C. MBBS

Plastic and Reconstructive Surgery: October 2013 - Volume 132 - Issue 4S-1 - p 8–9
doi: 10.1097/01.prs.0000435869.62118.e9
Saturday, October 12, 2013
Best Abstract

DISCLOSURES: Doctors Findlay and Behan have co-authored a textbook on the Keystone flap: “The Keystone Perforator Island Flap Concept.” Published through Elsevier (Reference 3).

INTRODUCTION: Worldwide, populations are aging. Survival in head and neck cancer is improving, increasing the incidence of additional or recurrent tumors and re-operative head and neck surgery, especially in Australia. The expense of free tissue transfer in time, resources and money is emphasizing the need for simpler complementary reconstructions in the majority of cases, such as locoregional flaps based on Keystone Island Flap Principles. Rigorous outcomes assessment of Keystone and related flaps in head and neck reconstruction has been lacking with the absence of any large series within the literature to date.1–4

METHODS: We undertook a retrospective review of 200 Keystone and related locoregional island flaps for fasciocutaneous head and neck reconstruction at the Peter MacCallum Cancer Centre and The Western Hospital between February 2006 and May 2012. Only cases with defect sizes over 4cm2 and with complete datasets, were included in the analysis.

RESULTS: 200 flaps were performed in 195 patients (164 male, 32 female). Median patient age was 76 (range 19-98 years) with an average of 2 comorbidities each (+/- 1.45, SD). Squamous cell carcinoma (100), melanoma (45) and basal cell carcinoma (34) were the most common tumour defects reconstructed with a mixture of other less common tumours. The median defect size reconstructed was 22.5cm2

CONCLUSION: Keystone island flaps provide effective fasciocutaneous reconstruction in the head and neck. The have comparable or lower morbidity than other reconstructive options (Table 1) within the published literature, making them a useful technique for our aging populations. Their preservation of reconstructive lifeboats for tumor recurrence is ideal.

Table 1

Table 1

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1. Behan FC, Lo CH, Sizeland A, et al. Keystone island flap reconstruction of parotid defects. Plast Reconstr Surg. 2012;130:36e–41e
2. Behan FC, Rozen WM, Wilson J, et al. The cervico–submental keystone island flap for locoregional head and neck reconstruction. J Plast Reconstr Aesthet Surg. 2013;66:23–28
3. Behan F, Findlay MW, Lo CH. The Keystone Perforator Island Flap Concept: Sydney, Elsevier Australia, 2012.
    4. Behan F, Sizeland A, Gilmour F, et al. Use of the keystone island flap for advanced head and neck cancer in the elderly – a principle of amelioration J Plast Reconstr Aesthet Surg. 2009
      5. Wei FC, Jain V, Celik N, et al. Have we found an ideal soft–tissue flap? An experience with 672 anterolateral thigh flaps Plast Reconstr Surg. 2002;109:2219–2226 discussion 2227–2230
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