Felix Behan – författare

Worldwide, it is quoted that 85% of Melanoma cases are treated surgically. The reliability of the Keystone Perforator Island Flap (KPIF) as a reconstructive technique has wide applications.  Its low complication rate is the key to its surgical success. The technique is clearly explained in this Atlas by the author, a renowned plastic and reconstructive surgeon, who established this reconstructive principle over 20 years.   The illustrations range from simple to complex cases in an easy-to-follow format.   Audio files, as a supplementary tool, amplify the technique to enhance the reader’s experience and foster clear understanding. Chapters focussing on anatomical regions contain carefully selected cases accompanied by images to demonstrate a step-by-step surgical technique.  The basic design format for all Keystones are highlighted, all sitting within the dermatomal precincts.  The KPIF must contain a fascial base for lining and the island outline is an essential pre-requisite.  It is hypothesized that this islanding creates a sympathectomy effect resulting in hyperaemic blood flow which optimises healing.  Undermining up to 2/3 is permissible as long as there is a deep attachment of 1/3 at the base of the flap to contain the random perforator vascular support.  This design allows the rotation, advancement and transposition (ART) of the flap to facilitate the reconstructive closures. Presumably, there are somatic and autonomic neural support lines accompanying the vascular pathways of these random perforator flaps.  The vascular perforator tree must not be skeletonised (as in propellor flaps) to allow preservation of such anatomical elements - somatic, autonomic and lymphatic pathways, all of which are an essential component in any surgical repair.  This KPIF provides an alternative to microvascular procedures where the biggest drawback is tissue match.  The KPIF addresses this problem admirablywith a low pain component, an excellent aesthetic match with a low vascular complication rate and a performed in an expeditious manner – these all characterise the KPIF.  Simple solutions solve problems and this KPIF Atlas for Melanoma becomes a welcome companion to any surgical speciality including plastic and reconstructive surgeons, surgical oncologists, general surgeons and dermatologists.

KDPIF, or Keystone Design Perforator Island Flap, is the main reconstructive tool available as a valid alternative to microsurgical procedures; its low complication rate is the key to its surgical success. This stepwise guide illustrates the technique’s applications in orthopaedic reconstruction. The sections of the book cover the upper limb (including Dupuytren’s disease), the lower limb defects (from groin to foot) and the rare vascular complications of the technique. The illustrations range from simple to complex cases in an easy-to-follow format, with audio files, acting as a supplementary tool to amplify and illustrate the technique to enhance the reader’s experience and foster clear understanding. The basic design format for all Keystones are highlighted, all sitting within the dermatomal precincts. The KDPIF must contain a fascial base for lining and must be aligned within the dermatomal precincts.  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 drawback is tissue match. The KDPIF addresses this problem admirably with a low pain component, an excellent aesthetic match with a low vascular complication rate and executed in an expeditious manner with sensory recovery and resolution of oedema. Keystone Flap for Complex Orthopaedic Problems: Reconstructive Surgery with Audiovisual Guidelines will be a valued companion to plastic and reconstructive surgeons and orthopaedic surgeons, that might find a valid alternative to  microsurgical techniques.