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without compromising on flap vascularity. In short, the A keystone‑design perforator‑based flap is based on
key message of this small case series is to emphasize a synthesis of well‑established concepts. It provides a
perforator identification, visualization, and preservation, solution for performing a local flap in a difficult region
while elevating keystone flaps on the leg. such as the leg, where lax and mobile skin is at a premium.
We find a parallel to the discovery of this idea, in the REFERENCES
evolution of the propeller perforator concept. The propeller
flap was originally described for coverage of elbow or 1. Behan F, Lo C. Principles and misconceptions regarding the keystone island
axillary defects. The flap had a central adiposofascial flap. Ann Surg Oncol 2009;16:1722‑3.
pedicle, which contained perforators. The existence of 2. Khouri JS, Egeland BM, Daily SD, Harake MS, Kwon S, Neligan PC,
these perforators was presumed, and they were never Kuzon WM Jr. The keystone island flap: use in large defects of the
actively sought for or identified. However on the lower trunk and extremities in soft‑tissue reconstruction. Plast Reconstr Surg
2011;127:1212‑21.
extremity, most propeller flaps are nowadays elevated on 3. Pauchot J, Chambert J, Remache D, Elkhyat A, Jacquet E. Geometrical
a single perforator, painstakingly skeletonized and twisted analysis of the V‑Y advancement flap applied to a keystone flap. J Plast
up to 180°. Reconstr Aesthet Surg 2012;65:1087‑95.
4. Moncrieff MD, Bowen F, Thompson JF, Saw RP, Shannon KF, Spillane AJ,
In the present series, care was taken to include only Quinn MJ, Stretch JR. Keystone flap reconstruction of primary melanoma
limited defects of the lower extremity, which required excision defects of the leg‑the end of the skin graft? Ann Surg Oncol
2008;15:2867‑73.
a local flap to advance up to 3 cm. Some important 5. Douglas CD, Low NC, Seitz MJ. The keystone flap: not an advance, just a
limitations have to be mentioned. Free tissue transfer is stretch. Ann Surg Oncol 2013;20:973‑80.
the primary choice especially for larger, posttraumatic
defects. A split thickness graft close to the site of the How to cite this article: John JR, Balan JR, Tripathy S, Sharma RK,
flap may not be ideal for patients undergoing cancer Jadhav C. The keystone-design perforator-based flap for leg defects: a
synthesis of philosophies. Plast Aesthet Res 2014;1:70-2.
excision, as they require radiotherapy. It is difficult to
elevate the skin‑grafted tissue for future operations Source of Support: Nil, Conflict of Interest: None declared.
too. Received: 09-05-2014; Accepted: 11-07-2014

72 Plast Aesthet Res || Vol 1 || Issue 2 || Sep 2014