An Innovative Single‐Stage Approach of High‐Tension Keloid Excision and Reconstruction Using Acellular Dermal Matrix and Epidermal Skin Grafting

Abstract

The treatment of keloids, particularly in high‐tension areas, is challenging due to their extension beyond the original wound boundaries and high recurrence rates, thereby rendering traditional treatments ineffective. In this study, we investigated the effectiveness of a novel single‐stage treatment approach that combined acellular dermal matrix (ADM) with keloid‐specific epidermal skin grafting. To further prevent recurrence after neo‐skin formation, the treatment was followed by fractionated laser and radiation therapy (LCR). Seven patients with high‐tension keloids, including one with keloids at two locations, were treated and followed‐up for an average of 15.9 months. The patients showed significant improvements in wound healing and skin appearance, with a marked reduction in the Patient and Observer Scar Assessment Scale (POSAS) (scores from 91.1 ± 5.6 to 23.8 ± 6.1 (p < 0.001)). This approach effectively minimizes tension, reduces the likelihood of keloid recurrence, and serves as a viable alternative to conventional methods that often involve challenges related to donor‐site acquisition. No recurrence was observed during the follow‐up period, indicating a promising innovation in the management of extensive keloids and offering improved healing and esthetic outcomes, particularly in high‐tension areas.