Uneasy (Intractable) Head and Neck Defect Coverage With Easy and Reliable Local Flap Techniques: A Retrospective Case-Based Study of Perforator-Plus Peninsular Flap and Modified Keystone Flap

Objectives: Head and neck defects are challenging to reconstruct. Local flaps, preserving donor sites, offer optimal results. This study evaluated perforator-plus peninsular flaps (PPPF) and modified keystone flaps (MKF) for reconstructing “uneasy” defects lacking clear solutions. Methods: Records of patients undergoing PPPF or MKF were reviewed. Defects were defined as “uneasy” if two of three experienced plastic surgeons could not suggest a local flap within 10 min. Data on demographics, defect features, flap type, complications, and Patient and Observer Scar Assessment Scale (POSAS)-based scar outcomes were analyzed. Results: Ten patients (mean age, 50.3 years) were included. Defects involved the scalp and forehead (60%), ear (20%), cheek (10%), and neck (10%) with a mean size of 16.5 cm². All flaps (PPPF 40%, MKF 60%) survived without complications. Mean POSAS scores were 15.1 (patient) and 18.3 (observer). Conclusion: PPPF and MKF offer reliable solutions for uneasy head and neck defects.