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 cm 2 . 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.