Abstract
Background The Keystone Design Perforator Island Flap (KDPIF), first described by Behan in 2003,
has been demonstrated as a versatile, safe, and straightforward reconstructive option
for various soft tissue defects. The purpose of this systematic review is to evaluate
the indications, variations, and overall complication profile of the keystone flap
in reconstructive surgery.
Methods A literature review was conducted in accordance with PRISMA guidelines using MeSH
term “surgical flaps” with the keyword “keystone flap.” Empirical studies with at
least 15 patients who underwent keystone flap reconstruction were assessed for quantitative
analysis. Outcomes of interest included patient demographics, indications, anatomic
location, flap design, and complications.
Results Database search produced 135 articles, of which 25 were selected for full-text review.
Out of 23 studies selected qualitative analysis and 22 met criteria for quantitative
analysis. Overall success rate of this flap was 98%. Wound complications were highest
in extremity flaps. Several modifications of this flap were described.
Conclusion Keystone reconstruction demonstrates excellent success rates and versatility. However,
further studies with more standard reporting are needed to determine guidelines for
patient specific surgical planning.
Keywords
keystone flap - perforator flap - reconstructive surgery
