Atlas of Keystone Reconstructive Technique in Melanoma Management

Felix C. Behan has a wide experience in Plastic and Reconstructive Surgery 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.   He was instrumental in establishing the reconstructive loco-regional flap called the Keystone Perforator Island Flap – KPIF, which has been the main reconstructive tool as an alternative to microsurgical procedures.  The first publication of this 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 in this clinical record of over 3,500 flaps over 20 years.  The characteristics which are so clinically relevant in Reconstructive Surgery 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 in the 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 was in the public service domain.

• 1. Principles of the Keystone.- 2. Major Head and Neck Regions Using the Keystone Technique.- 3. Major Trunk Defects Using the keystone Technique.- 4. Major Upper Limb Defects Using the Keystone Technique.- 5. Lower Limb Major Defects Closed with a KPIF technique.- 6. Conclusion.