A keystone solution for major head and neck reconstructions

This ‘How to do it’ lists a range of cases, demonstrated by supplementary video discussion, that explain the refinements of the keystone perforator island flap (KPIF) technique applied to specific sites of the head and neck, with a focus on the elderly. When the P A C E acronym is applied (pain-free, aesthetic outcome, minimal complications, economical) the KPIF technique is a respectable alternative to microvascular surgery, particularly in the elderly, with minimal returns to theatre for vascular impedance problems which are not infrequent in microvascular reconstructions.