{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,5]],"date-time":"2026-10-05T16:53:52Z","timestamp":1791219232208,"version":"4.1.0"},"reference-count":44,"publisher":"MDPI AG","issue":"1","license":[{"start":{"date-parts":[[2025,12,29]],"date-time":"2025-12-29T00:00:00Z","timestamp":1766966400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100002647","name":"Sungkyunkwan University","doi-asserted-by":"crossref","id":[{"id":"10.13039\/501100002647","id-type":"DOI","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: Facial reconstruction using keystone flaps (KFs) provides reliable outcomes; however, few studies have evaluated postoperative scarring using patient-reported 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 \u00b1 20.66 [range, 10\u201388] years) who underwent facial KF reconstruction between January 2020 and November 2022 were stratified by age (\u226430, 40s\u201350s, \u226560 years), KF type (hemi-KF vs. other types), and sex. Results: Patients aged \u226430 years showed significantly higher total Patient Scar Assessment Scale (PSAS) scores (18.53 \u00b1 5.69) than those aged 40s\u201350s (13.33 \u00b1 3.27) and \u226560 years (11.82 \u00b1 3.28) (p &lt; 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. Patient-reported scar assessments are essential for individualized counseling, planning, and scar care in facial reconstruction.<\/jats:p>","DOI":"10.3390\/jcm15010262","type":"journal-article","created":{"date-parts":[[2025,12,31]],"date-time":"2025-12-31T14:33:25Z","timestamp":1767191605000},"page":"262","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Patient and Observer Scar Assessment of Facial Keystone Flap Reconstruction in Korean Patients"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0009-0000-9577-3732","authenticated-orcid":false,"given":"Wooseob","family":"Kim","sequence":"first","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eun A","family":"Jang","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kap Sung","family":"Oh","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9998-8722","authenticated-orcid":false,"given":"Kyu Nam","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Plastic and Reconstructive Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,12,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e14167","DOI":"10.1097\/MD.0000000000014167","article-title":"Relaxed skin tension line\u2013oriented keystone\u2013designed perforator island flaps considering the facial aesthetic unit concept for the coverage of small to moderate facial defects","volume":"98","author":"Yoon","year":"2019","journal-title":"Medicine"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1832","DOI":"10.12998\/wjcc.v8.i10.1832","article-title":"Keystone design perforator island flap in facial defect reconstruction","volume":"8","author":"Lim","year":"2020","journal-title":"World J. 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