This guide summarises the keystone perforator island flap (KPIF) in lower limb reconstruction from the groin to the ankle.
Depending on the anatomical site and the dermatome locations, the KPIF can be rhomboidal or rectangular in shape. Gillies principle of reconstructing tissue defects using ‘like with like’ is integral to the KPIF’s ability to provide an aesthetic reconstruction.
An absolute prerequisite for this technique is to have the KPIF ‘fascial lined’. The flap can be undermined by up to two thirds. The flap’s longitudinal axis is orientated parallel to and along the dermatomal precincts.
The controversial aspect of creating an island in the skin and subcutaneous tissue only has the dynamic effect of forcing the circulation to the random perforator support and eliminating the subdermal plexus.
The vascular reaction of this islanding is illustrated by the hyperaemia that is consistently observed, suggesting an increase in blood flow. The clinical sign of this hyperaemia, termed the ‘red dot sign’, is that it bleeds more on the flap side than the receiving side. This hypervascularity allows closure of the flap under tension.
The clinical characteristics are best summarised by the acronym ‘PACE’ which refers to:
An audio-visual presentation describing key procedural steps of Felix Behan’s KPIF technique for lower limb reconstructions can be found on the AJOPS YouTube channel: https://youtu.be/cwmFD4mucwo
In summary, the acronym ‘PACE’ unifies the KPIF concept—a relatively pain-free postoperative phase, good aesthetic outcome, low complication rates, efficient timeframe—and finally, the regaining of topical sensation.
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The authors have no conflicts of interest to disclose.
The authors received no financial support for the research, authorship, and/or publication of this article.