S-shaped Wound Closure Technique for Dumbbell-shaped Keloids

Abstract

Summary:Dog-ear collection, Z-plasty, and W-plasty are often performed for excision of dumbbell-shaped keloids; however, these procedures require additional incisions or excision of normal skin. Thus, an S-shaped wound closure technique was performed. The keloid lesions were extralesionally excised above the deep fascia, and the wound edges were shifted in opposite directions along the major axis to form an S-shape. The incision was closed by applying deep fascial sutures, subcutaneous sutures, and superficial sutures. Postoperative external beam radiation therapy was started within 6 hours after surgery at a dose of 20 Gy applied in 4 fractions. All wounds were covered with silicone-gel sheeting and fixed with tape after suture removal. No intralesional corticosteroid injection or oral tranilast was administered. Corticosteroid tape was applied in cases with suspected postoperative recurrence. Scoring was performed using the Manchester Scar Scale. A total of 8 lesions were treated. Temporary erythema and scar elevation were observed in 2 chest lesions; however, both were flattened and turned white using corticosteroid tape. Other than these 2 lesions, there was no recurrence or complication. The mean score improved from 15.8 to 7.2. The S-shaped wound closure technique has 3 advantages. First, no additional incision or excision is required, and additional scarring and keloid recurrence can be avoided. Second, aesthetic results are good, and noticeably long and zigzag-shaped scars can be avoided. Third, dispersion of tension on the scar can be expected. Although the S-shaped wound closure technique has limited application, it is a useful option for keloid treatment.

Surgical Core Excision With Tongue Flap Closure in Combination With Electron Beam Radiotherapy in the Treatment of Ear Keloids

“…31 Keloid exhibits 45% to 100% recurrence rates after surgery, so most surgeons refrain from using surgery as a monotherapy. 5,27,32 Accurate flap design, delicate excision of the core, preservation of the required flap tissue, protection of the ear contour, prevention of cartilage damage, tension-free wound closure, and strict postoperative follow-up to detect recurrence are imperative for the success of tongue flap surgery. Complete excision of the ear keloid might cause deformities such as cup ear or protruding ears, so it is necessary to avoid unnecessary excision of keloid tissue.…”

“…31 Keloid exhibits 45% to 100% recurrence rates after surgery, so most surgeons refrain from using surgery as a monotherapy. 5,27,32…”

Surgical considerations in skin of colour: minimizing pathological scars

“…Wound tension and inflammation plays a key role in the process of wound healing and scar formation. Tension‐relieving closure techniques such as Z‐, S‐ 23 or W‐plasty and use of injectable adjuncts such as steroids (e.g. triamcinolone acetonide), 24 5‐fluorouracil, 24 mitomycin, 25 bleomycin 25 and botulinum toxin A (BoNT‐A) 26 can also be used where appropriate in patients with a known history of keloid scarring.…”

“…22 Wound tension and inflammation plays a key role in the process of wound healing and scar formation. Tension-relieving closure techniques such as Z-, S- 23 or Not all patients will need every treatment modality mentioned above; however, most patients at high risk will require some of the treatment modalities mentioned in the 0-week to 1-month sections initiated in that time span to prevent or significantly minimize hypertrophic or keloid scarring. Intralesional agents and/or radiotherapy are usually required once a keloid scar starts forming in these high-risk groups.…”

S-shaped wound closure following the excision of 2 adjacent pigmented nevi

“…As reported in the literature, when there is appropriate distance between the 2 nevi, a S-shaped suturing method might be a good choice (1). The S-shaped wound closure method was first reported for the resection of dumbbell-shaped keloids (2). In this model, 2 adjacent nevi are cut along the edges, and the normal skin in the middle is used to fill in the cuts, while leaving the defects; finally, an S-shaped wound is formed.…”