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This retrospective observational cohort study evaluated Korean patients after facial KF reconstruction using the Patient and Observer Scar Assessment Scale (POSAS), analyzing links with clinical variables and sociodemographic factors. Forty-three patients treated between January 2020 and November 2022 were stratified by age, KF type, and sex. Younger participants (≤30) reported higher patient scar scores, while observer ratings and satisfaction showed limited differences.",{"@graph":69,"@context":122},[70,84,105],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/patient-and-observer-scar-assessment-of-facial-keystone-flap-reconstruction-in-korean-patients/461620/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/patient-and-observer-scar-assessment-of-facial-keystone-flap-reconstruction-in-korean-patients/461620.png","ImageObject",300,407,{"name":92,"@type":93},"RuangKosong","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-10-30","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":34},"InteractionCounter",{"@type":104},"ViewAction",{"@type":106,"mainEntity":107},"FAQPage",[108,114,118],{"name":109,"@type":110,"acceptedAnswer":111},"Which scale was used to assess scars after facial keystone flap reconstruction?","Question",{"text":112,"@type":113},"The study used the Patient and Observer Scar Assessment Scale (POSAS), including patient and observer components.","Answer",{"name":115,"@type":110,"acceptedAnswer":116},"How many Korean patients were included, and what period was studied?",{"text":117,"@type":113},"Forty-three Korean patients were included, undergoing facial KF reconstruction between January 2020 and November 2022.",{"name":119,"@type":110,"acceptedAnswer":120},"What patient-related factors influenced scar ratings in the results?",{"text":121,"@type":113},"Patients aged ≤30 years showed significantly higher total patient scar assessment scores than older age groups, and female patients reported higher PSAS scores.","https://schema.org",{"og:url":83,"og:type":124,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":126,"canonical":83},"index,follow",{"doc_id":128,"site_id":62},461620,1790811623,{"code":4,"msg":5,"data":131},{"doc_id":128,"user_id":132,"nickname":92,"user_avatar":133,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":134,"file_id":135,"file_url":136,"file_type":137,"file_size":138,"view_count":34,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":139,"language":140,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":141,"faqs":142,"seo_title":143,"seo_description":67,"update_tm":144,"read_time":41,"preview_page_count":4},962090883219,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","Article  \nPatient and Observer Scar Assessment of Facial Keystone Flap Reconstruction in Korean Patients  \nWooseob Kim †, Eun A Jang†, Kap Sung Oh and Kyu Nam Kim *  \nAcademic Editor: Rami S. Kantar  \nReceived: 10 December 2025  \nRevised: 26 December 2025  \nAccepted: 26 December 2025  \nPublished: 29 December 2025  \nCopyright: © 2025 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license.  \nDepartment of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea; [wskim2404@naver.com](wskim2404@naver.com) (W.K.);  \n[insane.blood.a@gmail.com](insane.blood.a@gmail.com) (E.A.J.); [kapsung.oh@samsung.com](kapsung.oh@samsung.com) (K.S.O.)  \n* [Correspondence: manabear77@naver.com](Correspondence: manabear77@naver.com); Tel.: +82-10-6485 0584 † These authors contributed equally to this work.  \nAbstract  \nBackground/Objectives: Facial reconstruction using keystone flaps (KFs) provides reliable outcomes; however, few studies have evaluated postoperative scarring using patientreported outcomes. We assessed scar outcomes after facial KF reconstruction using the Patient and Observer Scar Assessment Scale (POSAS) and explored associations with clinical and sociodemographic factors. Methods: In this retrospective observational cohort study, 43 Korean patients (27 males, 16 females; mean age: 49.95 ± 20.66 [range, 10–88] years) who underwent facial KF reconstruction between January 2020 and November 2022 were stratified by age (≤30, 40s–50s, ≥60 years), KF type (hemi-KF vs. other types), and sex. Results: Patients aged ≤30 years showed significantly higher total Patient Scar Assessment Scale (PSAS) scores (18.53 ± 5.69) than those aged 40s–50s (13.33 ± 3.27) and ≥60 years (11.82 ± 3.28) (p \u003C 0.001) . Observer Scar Assessment Scale and patient satisfaction scores did not significantly differ across flap types or sex; however, the hemi-KF group showed a trend toward better outcomes, and female patients reported higher PSAS scores. Conclusions: Facial KF reconstruction yields generally satisfactory scar outcomes. Younger patients are more critical of scars, and female patients exhibit greater aesthetic sensitivity. Patientreported scar assessments are essential for individualized counseling, planning, and scar care in facial reconstruction.  \nKeywords: facial reconstruction; facial keystone flap; scars  \n1. Introduction  \nFacial defects are common in plastic surgery and require meticulous planning, even for small lesions [1,2] . As the face is the primary focus of aesthetics and function, reconstruction must balance both cosmetic and functional goals [1–4] . Local flaps remain the standard approach, often producing favorable outcomes [1,2,5] . However, additional scars from flap harvest sites may compromise the final aesthetic result [5–7] . Minimizing postoperative scarring is therefore essential in facial reconstruction, and scar assessment provides useful feedback for improving cosmetic outcomes [5–7] . Various local flap techniques—including Limberg, rhomboid, bilobed, V-Y, axial, and perforator-based flaps—are commonly used to address facial defects [1,2,5,8–13] . Scar outcomes have been evaluated using scales such as the Vancouver Scar Scale, Manchester Scar Scale, and the Patient and Observer Scar Assessment Scale (POSAS), with varying results [6,14–17] .  \nAmong these techniques, the keystone flap (KF) and its modifications are increasingly used for facial reconstruction, offering technical simplicity, broad applicability, and  \nreproducibility with an easy learning curve. Studies have reported successful facial KF reconstruction with reliable and favorable outcomes [1,2,8,9] . However, only a few studies have focused on scar evaluation using patient-reported outcome measurements (PROMs) in facial KF reconstruction.  \nAccordingly, t","cbCailFEhGOaiYya","https://ap.wps.com/l/cbCailFEhGOaiYya","pdf",1460782,12,"English","# Abstract\n## Background/Objectives\n## Methods\n## Results\n## Conclusions\n# Introduction\n## Rationale for scar assessment in facial reconstruction\n# Materials and Methods\n## Ethical approval and study design\n## Surgical techniques (modified keystone flap types)","[{\"question\":\"Which scale was used to assess scars after facial keystone flap reconstruction?\",\"answer\":\"The study used the Patient and Observer Scar Assessment Scale (POSAS), including patient and observer components.\"},{\"question\":\"How many Korean patients were included, and what period was studied?\",\"answer\":\"Forty-three Korean patients were included, undergoing facial KF reconstruction between January 2020 and November 2022.\"},{\"question\":\"What patient-related factors influenced scar ratings in the results?\",\"answer\":\"Patients aged ≤30 years showed significantly higher total patient scar assessment scores than older age groups, and female patients reported higher PSAS scores.\"}]","Patient and Observer Scar Assessment of Facial Keystone Flap Reconstruction in Korean Patients | PDF",1790761988]