Fig. 4
a A 21-year-old woman with a large keloid on the lower abdomen, experiencing significant discomfort and severe pain caused by a belt. b A 6.0 × 4.0 cm defect following resection of the keloid. c A keystone flap designed for reconstruction on the upper side of the defect because of a lack of surrounding tissue laxity and quality, with other keloids on the lower side. d Immediate postoperative result of the fortune cookie design perforator island flap with V-Y closure of the donor site with a drain in situ. e No remnant proliferating collagen core on the surgical resection margin is shown, which is related to local recurrence