title: Keystone Perforator Island Flap as an Alternative Reconstructive Option for Partial Thickness Alar Defects Up to 1.5 Centimeters.
abstract: BACKGROUND
  The ala is a unique landmark of the nose disposing aesthetic and functional properties. The head and neck area is the main site of appearance of nonmelanoma skin cancer. One third of them are located in the nose with an alar preponderance compared with other nasal subunits. Correction of alar defects is a challenging reconstructive task. The keystone perforator island flap (KPIF) was introduced as an alternative in nasal reconstruction by senior authors. In the present case series, KPIFs' application is introduced into the alar subunit as an alternative, versatile, and reproducible reconstructive option, even for the novice plastic surgeon.
  
  
  METHODS
  From April 2014 to September 2015, patients presenting with partial thickness alar defects (≤1.5 cm) secondary to tumor extirpation sustained reconstruction with different types of KPIF.
  
  
  RESULTS
  A total of 31 patients (mean age of 72 years) were treated with various types of KPIF. The mean diameter of the defect was 1.14 cm. The vast majority of reconstructions concerned a type IV KPIF (18/31 or 58.1%). Sometimes an upward alar retraction was noted. A minimal rim wedge excision was performed (≤0.3 mm) using counterbalancing correcting sutures. All flaps survived without any sign of venous congestion, whereas the rim healed uneventfully. The mean follow-up period was 6.5 months.
  
  
  CONCLUSIONS
  KPIF was introduced as a single-stage alternative reconstructive option for partial thickness alar defects, completing author's experience with this flap into such a challenging and aesthetically critical anatomic area.
authors.affiliation: Department of Plastic Surgery, "A. Syggros" Hospital, National and Kapodestrian, University of Athens, Athens Medical School, Athens, Greece.
authors.forename: Epameinondas
authors.initials: E
authors.lastname: Kostopoulos
authors.forename: Christos
authors.initials: C
authors.lastname: Agiannidis
authors.forename: Petros
authors.initials: P
authors.lastname: Konofaos
authors.forename: Ioannis
authors.initials: I
authors.lastname: Kotsakis
authors.forename: Grigorios
authors.initials: G
authors.lastname: Champsas
authors.forename: Marios
authors.initials: M
authors.lastname: Frangoulis
authors.forename: Othon
authors.initials: O
authors.lastname: Papadopoulos
authors.forename: Vincent
authors.initials: V
authors.lastname: Casoli
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D055171:Nasal Cartilages / Q000000981:diagnostic imaging / Q000601:surgery*; D009667:Nose Deformities, Acquired / Q000175:diagnosis / Q000209:etiology / Q000601:surgery*; D009669:Nose Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D061525:Perforator Flap; D012225:Rhinoplasty / Q000379:methods*; D012720:Severity of Illness Index; D055815:Young Adult