The Keystone Perforator Flap Concept – A Useful Tool in the Armamentarium of Plastic Surgery

Closure of skins and soft tissue defects is a mainstream procedure in the field of reconstructive plastic surgery. Nowadays plenty of reconstructive options exists in the armamentarium of the specialty. The “keystone island perforator flap” is a relatively new conception which consists of taking skin and superficial fascia in a keystone pattern adjacent to the defect that needs to be covered. This technique is based on the most contemporary knowledge of the vascularization and three-dimensional vascular architecture of the skin and soft tissue overlying the bones - the so called angiosomes and perforasomes concepts. In the present article a brief review of the main keystone fl ap types and on their predecessor - the Bezier flap, was made. Two clinical cases with difficult defects on the limbs are presented and discussed in order to illustrate the application of that approach. The keystone perforator island flaps is a sophisticated and relatively easy option for defect closure. However, this surgical concept still remains unpopular in the Bulgarian practice and science of plastic surgery. To the best of our knowledge this paper is the first one focused on the topic.