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THE INTEROSSEOUS KEYSTONE PERFORATOR ISLAND FLAP (IKPIF): A NOVEL TECHNIQUE FOR MINIMIZING RADIAL FOREARM FLAP DONOR MORBIDITY
Presenter: Michael W Findlay, MBBS, PhD, FRACS
Co-Authors: Rozen WM; Pratt G; Fairbank S; Choi WT; Hunter-Smith D; Behan FC; Gurtner GC
Stanford University

Concerns about the morbidity of the radial forearm flap (RFF) donor defect have limited use of this flap. Reliable fasciocutaneous reconstruction of the RFF donor site would improve esthetics and minimize risk of tendon exposure. An interosseous keystone perforator island flap (IKPIF) was developed for closure of RFF defects by examining the remaining vascularity and suitable local tissue donor sites in the forearm. In parallel, an approach to maximise the potential for either primary closure or local flap closure alone was developed for RFF harvest. These approaches were then validated in a prospective study of 10 consecutive clinical cases using the IKPIF for RFF closure. The modified RFF harvest technique permitted direct closure of two RFF defects without the need for additional grafts/flaps. The IKPIF provided up to 122cm2 for defect closure in 10 consecutive flap cases, including defect diameters up to 40% of the forearm circumference and all flaps were completely viable. The median RFF defect diameter and surface area were 5.75cm and 55cm2 respectively. A small skin graft was necessary in only 3 cases with avoidance of grafting over tendons in all cases using this approach. A single case had delayed graft healing, otherwise there were no complications. This novel technique decreases donor morbidity associated with RFF harvest, is simple and safe to perform.


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