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

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.