Keystone Reconstructive Solutions for Major Surgical Defects
Description
KDPIF, or Keystone Design Perforator Island Flap, has proven to be a reliable solution for complex surgical defect reconstructions, offering consistent results with reduced complications. The illustrations cover complex cases in a clear format, with video audio files, acting as a supplementary tool to illustrate the technique and expand the reader's experience to show others how to simply master the technique. The basic design format for all Keystones is highlighted, all sitting within the dermatomal precincts. The KDPIF must contain a fascial base for lining and must be aligned within the dermatomal precincts which ensures their neurovascular and lymphatic input. This island outline is an essential pre-requisite for its success. It is hypothesized that this islanding creates a sympathectomy effect resulting in hyperaemic blood flow which optimises healing: the KDPIF technique provides an alternative to microvascular procedures where the biggest drawbacks are theatre time and tissue match which reduces aesthetics. The KDPIF addresses these problems admirably with a low pain component, an excellent aesthetic match with a low vascular complication rate when executed in an expeditious manner, with sensory recovery and resolution of oedema. The first publication of this Keystone principle occurred in the ANZ Journal of Surgery in 2003 and its applications since have resulted in over 35 further peer reviewed publications leading to textbook publications applying these principles all over the body.
Volume 1 explains the technique's embryological foundation and evolution, while focusing on major reconstructions of the head and neck region-including the parotid, ear, nose, lips, scalp, and forehead. Detailed illustrations and clinical outcomes support key concepts such as the sympathectomy effect, dermatomal alignment, and tension-free closure, reinforcing why the Keystone flap can replace more complex microsurgical methods. With its wealth of cases and stepwise indications, Keystone Reconstructive Solutions for Major Surgical Defects Vol. 1 will be a valued companion to plastic and reconstructive surgeons and general surgeons, offering a sound alternative to microsurgical techniques.
More details
Person
Associate Professor Felix Behan pioneered the reconstructive loco-regional flap called the Keystone Perforator Island Flap. He has a wide experience in Plastic and Reconstructive Surgery, first following his surgical training and clinical attachments in London at the St George's, Royal Marsden and Westminster Hospitals. He has continued in this facility in Head and Neck cancer surgery at the Peter MacCallum Cancer Institute where his appointment in the Head and Neck service extended from 1977 to 2014. He was instrumental in establishing the Melanoma Unit at the Peter MacCallum Cancer Institute, which is now part of the Department of Surgical Oncology. He was formerly Head of Unit in the Plastic & Reconstructive Hand Surgery at the Western Hospital from 1988 where 50% of the work relates to Hand Surgery with cases numbering in the thousands totally per year providing the variety of cases in the text. The first publication of the Keystone technique and principle occurred in the ANZ Journal of Surgery in 2003 and its applications since has resulted in over 35 further peer reviewed publications applying the principles all over the body, even in irradiated tissue. He established this clinical record of over 3,500 flaps over 20 years. The characteristics which are so clinically relevant in the Keystone Perforator Island Flap are synopsised by the acronym P.A.C.E.S. - almost Pain free, satisfactory Aesthetic match, Complications of a vascular nature are extremely rare and Economic in terms of theatre time often completed under a 2-hour timeframe compared with the microsurgical alternative and Sensory recovery in usually 3-6 months over the island flap with resolution of oedema, even after a chronic long-term injury. His full-time commitment in surgery in the public service domain, was recognised in the 2024 Australia Day honours list and appointed as a Member of the Order of Australia (AM) for contributions to medicine and surgical teaching.
Content
1. General Embryological Principles of the Keystone Reconstructive Flap .- 2. Major Head and Neck Defects .- 3. Complications and Final Insights on Keystone Flap Applications in Head and Neck Reconstruction.