Algorithm of chest wall keloid treatment

Long, Xiao; Zhang, Mingzi; Wang, Yang; Zhao, Ren; Wang, Youbin; Wang, Xiaojun

doi:10.1097/md.0000000000004684

Cited by 12 publications

(13 citation statements)

References 20 publications

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“…Chest keloids are more likely in an exposed region, causing cosmetic concerns. Though there is a myriad of therapeutic options including surgical excision, intralesional steroid injection, laser therapy, and pressure therapy, their efficacy is mostly less than desirable …”

Section: Introductionmentioning

confidence: 99%

A parasternal intercostal perforator flap for esthetic reconstruction after complete chest keloid resection: A retrospective observational cohort study

Song

Wang

Zhang

et al. 2018

J of Cosmetic Dermatology

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Summary Objective To report on the outcome of 35 patients with chest keloids who were treated with intercostal perforator flap surgery plus local radiotherapy at our hospital. Methods We retrospectively analyzed the data of patients with chest keloid who under surgical resection at the Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China between March 2014 and July 2017. We retrieved patient demographic data, donor site position, the perforator pedicle, flap size, angle of flap rotation, complications, and recurrences from the medical records. All patients underwent perforator flap surgery for complete keloid resection followed by radiation at postoperative day 1 and 8 for a total dose 16‐18 Gy. Results Thirty‐five patients were included in the retrospective analysis. Their mean age was 45.3 years (range 24‐67 years). The mean keloid area was 5‐7 cm × 6‐10 cm. Surgeries were successful in all cases. There were no perioperative complications. Good outcome with no apparent scar growth was achieved in 88.6% of the cases, and 11.4% of the cases achieved satisfactory outcome with partial scar growth in the incision, but no keloid was observed. Twenty‐four months after surgery, none of the resected keloids recurred and none of the donor sites developed new keloids. Conclusion Intercostal perforator flap surgery is an effective and safe approach for repair of wound formed as a result of excision of relatively large chest keloids which cannot be directly appositioned.

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Section: Introductionmentioning

confidence: 99%

A parasternal intercostal perforator flap for esthetic reconstruction after complete chest keloid resection: A retrospective observational cohort study

Song

Wang

Zhang

et al. 2018

J of Cosmetic Dermatology

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“…19 According to our algorithm for chest keloid management, if the diameter of the chest keloid is within 3-10 cm, resection and internal mammary artery perforator (IMAP) flap or local flaps should be performed. 5 With the high tension in the chest, the choice of local flaps is limited. Tissue expander, keystone flap, and internal mammary artery perforator flap can be chosen.…”

Section: Discussionmentioning

confidence: 99%

“…4 According to our published algorithm for chest keloid management, local flaps or internal mammary artery perforator propeller (IMAP) flaps were used to repair the defect. 5 Other reconstructive options, such as z-plasty 6 and fortune cookie flap, 7 were also reported in the literature.…”

Section: Introductionmentioning

confidence: 99%

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Keystone‐designed perforator island flaps for reconstruction after chest keloid excision: A retrospective case series

Huang

Dong

Wang

et al. 2020

J of Cosmetic Dermatology

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Objective: We retrospectively evaluated the efficacy and safety of keystone-designed perforator island flaps for chest keloid reconstruction. Methods: We reviewed consecutive patients who received keystone flap reconstruction after chest keloid resection between January 2017 and February 2018. The patient demographic data, defect size, flap size, complications, and recurrence were recorded. Results: Thirty-eight patients were evaluated in this retrospective case series. After keloid resection, dimension of wound defects was 5.5-9.5 cm × 9.5-12.5 cm, with an average dimension of 7.3 cm × 10.7 cm. The dimension of keystone flaps was between 6-10 cm × 20-34.5 cm, with an average dimension of 7.5 cm × 25.5 cm. The flaps healed smoothly without any complication. There was no keloid recurrence with 15 months of follow-up. 89.4% of the patients had good outcome with no apparent scarring, and 10.6% patients had satisfactory outcome with localized scarring. Conclusions: Keystone-designed perforator island flap is an effective and reliable method for reconstruction following chest keloid resection.

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“…In recent years, the most common treatment for chest keloids is resection followed by radiotherapy [9] . To resect the keloids completely, clinicians needed to use skin graft, local aps or perforators for the reconstruction of wound after resection.…”

Section: Discussionmentioning

confidence: 99%

Large Chest keloids treatment with expanded parasternal intercostal perforator flap

Líu

Sui

Liu

et al. 2020

Preprint

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Background Chest keloids often converged into a large lesion on the chest in some patients. Such keloids often lead to obstacle to excision and reconstruction. We describe a surgical method for large chest keloids with expanded parasternal intercostal perforator flap (EPIPF).Methods Fifteen patients with chest keloid were treated with EPIPF in our department between August 2017 and Dec 2019. The surgical treatment was divided into two different phases. In the first phase, we implanted skin expanders into the layer under the deep fascia beside the keloids. The expander was expanded every week for about 3-4 months. In the second phase, the expander was removed, the keloid tissue was removed and an expanded perforator flap was then designed to cover the wound. Patients were followed-up after surgery. Complications after surgery were analyzed. Recurrence and the patients, satisfactory rate was recorded. Results Of the 15 patients, one patient complicated with undesirable small area wound healing. 11 were cured without scar hypertrophy or recurrence and four were partially cured with a small portion of scar hypertrophy. Eleven patients thought that the esthetic result was good (73.7%), and 4 patients thought the result was acceptable (26.7%). None patient was dissatisfied.Conclusion EPIPF are effective surgical method for managing large chest keloids. It can offer enough skin flap coverage for keloid wound resurfacing with stable blood supply to assure satisfactory results. Level of Evidence: Level IV, case series.

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Algorithm of chest wall keloid treatment

Cited by 12 publications

References 20 publications

A parasternal intercostal perforator flap for esthetic reconstruction after complete chest keloid resection: A retrospective observational cohort study

A parasternal intercostal perforator flap for esthetic reconstruction after complete chest keloid resection: A retrospective observational cohort study

Keystone‐designed perforator island flaps for reconstruction after chest keloid excision: A retrospective case series

Large Chest keloids treatment with expanded parasternal intercostal perforator flap

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