Keystone design perforator island flap in facial defect reconstruction

Figure 2 Schematic diagram of the keystone design perforator island flap movement. A: Cross-sectional diagram; B: The keystone design perforator island flap movement on the back is provoked by three main factors. The first factor (orange-colored oval) is the release of the thick dermis at the back; the second (blue-colored oval) is the release of the superficial fascia; and the last (green-colored oval) is the release of the deep fascia. Then, minimal flap undermining of the flap margin (purple-colored circle) is performed to preserve the integrity of the “central hot spot” of the perforators (red-colored oval). (Reprinted from Yoon et al[14], with permission from Springer Nature).