When functionally reconstructing extensive burns, particularly in mobile areas such as the joints and neck, it is desirable to use flaps that can stretch adequately. However, sometimes there is insufficient healthy donor skin. In such cases, skin that bears scars due to epidermal burn (EB), superficial dermal burn (SDB), or even deep dermal burn (DDB) can be used as local or regional flaps. Skin-grafted areas can also serve as scarred flaps. When using scarred flaps, two concerns must be kept in mind: the vascularity and elasticity of the flap. About vascularity, scarred flaps may experience poorer blood flow in the epidermis than normal, which can lead to epithelial necrosis. However, this can be obviated by the fact that scarred flaps can have stronger blood flow in the dermis, similar to the mechanism observed in delayed flaps, where the blood flow in the flap increases when the surrounding blood flow is obstructed. This means that if the dermis survives, it will epithelialize over time, thus repairing any epithelial necrosis. Another issue related to scarred flap vascularity is that the scarring can significantly alter the course of the vessels in the flap; this should be assessed before surgery. The second issue regarding scarred flap stretching is a major concern: scarred flaps stretch less after surgery than flaps with normal skin. However, this can be resolved by elevating a sufficiently large flap, such as one that is 120% the size that would normally be needed. Thus, scarred flaps can be successful if the surgeon ensures that the design is appropriate and carefully assesses the scarred skin preoperatively and intraoperatively. In 1981, Hyakusoku and colleagues reported on the effectiveness of scarred flaps that included the musculocutaneous vascular system [1]. Later, they reported a number of cases of scarred flap use [2–4].