An Approach to Keloid Reconstruction with Dermal Substitute and Epidermal Skin Grafting

Abstract

Keloids represent a challenging topic for reconstructive surgeons. Surgical debulking is the main treatment for these lesions, although recurrence rates are reported to be 45–100%. Here, we present a staged reconstructive approach through a dermal regeneration substrate and epidermal grafting in order to minimize recurrence and donor site morbidity. All keloids were excised down to healthy tissue. A bilaminar dermal regeneration template was used to reconstruction, with the silicone lamina oriented superficially. The second step of reconstruction was delayed for at least 21 days to allow for neodermal ingrowth. Once the protective lamina was removed, an epidermal skin graft was applied to the neodermis with nonocclusive dressing. This combined approach limits scar contracture facilitating tension-free wound healing with a consequent lower rate of recurrences.