Abstract
The keystone perforator island flap (KPIF) is popular in reconstructive surgery. However, despite its versatility, its biomechanical effectiveness is unclear. We present our experience of KPIF reconstruction in the human back and evaluate the tension-reducing effect of the KPIF. Between September 2019 and August 2020, 17 patients (51.82 ± 14.72 years) underwent KPIF reconstruction for back defects. In all cases, we measured wound tension at the defect and donor sites before and after KPIF reconstruction using a tensiometer. All defects occurred after complete excision of complicated epidermoid cysts and debridement of surrounding tissues. The defects were successfully covered with Type IIA KPIFs. All flaps survived, and there were no significant postoperative complications. The mean “tension change at the defect after Type I KPIF” and “tension change at the defect after Type II KPIF” were − 2.97 ± 0.22 N and − 5.59 ± 0.41 N, respectively, (P < 0.001). The mean “rate of tension change at the defect after Type I KPIF” and “rate of tension change at the defect after Type II KPIF” were − 36.54 ± 1.89% and − 67.98 ± 1.63%, respectively, (P < 0.001). Our findings confirm the stepwise tension-reducing effect of KPIF and clarify the biomechanics of this flap.
Highlights
The keystone perforator island flap (KPIF), a curvilinear-shaped trapezoidal flap devised by Behan in 2003, has been a popular reconstructive flap and a good alternative to other flaps for the past 20 years[1,2,3]
The center of the KPIF should be located near these hot spots, and the orientation of its longitudinal axis should correspond with the long axis of the defect to maximally capture the dominant perforators with linking vessels, thereby securing stable and reliable flap perfusion[3,7]
Behan considered that the vascularity of the KPIF was suprafascial, and intraracial network circulation from the perforator axis was randomly located; it must be located within the dermatomal precincts because the blood supply must run along with a nerve supply[1,5]
Summary
The keystone perforator island flap (KPIF), a curvilinear-shaped trapezoidal flap devised by Behan in 2003, has been a popular reconstructive flap and a good alternative to other flaps for the past 20 years[1,2,3]. Some authors claimed that wound closure using the KPIF flap did not reduce wound tension and, questioned the ability of the KPIF skin paddle to expand, based on the results of their in vitro (cadaveric) s tudy[13,16]. They mentioned that, unlike the KPIF, the V–Y flap had biomechanical b enefits[13,16]. The main purpose of this study was to clarify the stepwise tension-reducing effect of the KPIF technique, which can contribute to the understanding of the biomechanical benefits of the KPIF
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