# Retrospective Analysis of 50 Hemi-Keystone Flap Head and Neck Reconstructions with Scar Assessment

## TL;DR

This study evaluates the hemi-keystone flap technique for head and neck reconstruction, showing it provides good functional and aesthetic results with minimal complications.

## Contribution

The study provides a retrospective analysis of hemi-keystone flap outcomes in head and neck reconstruction, including detailed scar assessments.

## Key findings

- Hemi-keystone flaps had a mean surgery time of 29 minutes and low complication rates.
- Patient and observer POSAS scores indicated favorable scar outcomes and satisfaction.
- The technique was versatile, with 60% using single flaps and 32% using double flaps.

## Abstract

Background/Objectives: Skin and soft tissue defects of the head and neck are common challenges in plastic surgery and require reconstruction strategies tailored to defect size and depth. This study aimed to evaluate the clinical application and outcomes of the hemi-keystone flap (KF) technique and its modifications for head and neck reconstruction. Methods: A retrospective cohort study was conducted on 50 patients (36 males, 14 females; aged 9–92 years) who underwent hemi-KF reconstruction between September 2020 and March 2024. Data were collected on defect characteristics, flap design, surgical time, complications, scar outcomes, and follow-up duration. Scar outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS). Results: The mean defect and flap sizes were 4.68 ± 4.14 cm2 and 11.79 ± 16.69 cm2, respectively. Single original hemi-KFs were used in 60% of cases, and double hemi-KFs in 32%. The mean flap-surgery duration was 29.04 ± 14.56 min. Partial wound dehiscence occurred in 6% of cases. The mean follow-up period was 6.34 ± 5.43 months. The mean POSAS scores were 15.30 ± 3.59 (patient) and 17.12 ± 3.70 (observer), indicating favorable scar outcomes and patient satisfaction. Conclusions: The hemi-KF technique and its modifications are reliable and versatile options for head and neck reconstruction, offering favorable functional and aesthetic outcomes.