title: The keystone design perforator island flap. Part II: clinical applications.
abstract: BACKGROUND
  This curvilinear- and trapezoidal-shaped flap essentially consists of two conjoined V-Y flaps end to side. The vascular supply is supported by the subcutaneous vascular network and is dependent on fascial and muscular perforators. A review of 15 clinical cases was performed to assess the reliability and versatility of the flap.
  
  
  METHODS
  Twelve keystone flaps were performed following excision of skin tumours or post-traumatic defects in various locations, from the head and neck region, the trunk and the limbs.
  
  
  RESULTS
  No flap necrosis, even partial, was observed regardless of the site and the type of keystone used. Patients were almost pain free in the postoperative course. The aesthetic results are quite satisfactory, as the flap is aligned locally without evidence of the 'pincushioning' appearance sometimes seen around island reconstructions.
  
  
  CONCLUSIONS
  Elevation of the flap seems to evenly distribute the tensional forces without undermining. The flap is particularly useful in the repair of defects following skin cancer removal. Bulk is not a problem and good skin cover is achieved.
  
  
  CONCLUSIONS
  The presence of perforators and subcutaneous network distributed throughout the body create an environment which makes this flap universally applicable and extremely reliable.
authors.affiliation: Service de Chirurgie Plastique, Hôpital Pellegrin-Tondu, 33076 Bordeaux, France. philippe.pelissier@chu-bordeaux.fr
authors.forename: Philippe
authors.initials: P
authors.lastname: Pelissier
authors.forename: Hélène
authors.initials: H
authors.lastname: Gardet
authors.forename: Vincent
authors.initials: V
authors.lastname: Pinsolle
authors.forename: Max
authors.initials: M
authors.lastname: Santoul
authors.forename: Felix C
authors.initials: FC
authors.lastname: Behan
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D062109:Dermatologic Surgical Procedures; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012867:Skin / Q000293:injuries*; D012878:Skin Neoplasms / Q000601:surgery*; D013524:Surgical Flaps / Q000098:blood supply*