Abstract
BackgroundChest 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).MethodsFifteen 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.ResultsOf 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.ConclusionEPIPF 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 evidenceLevel IV, case series.
Highlights
Chest keloids often converged into a large lesion on the chest in some patients
We have reported using radiotherapy before skin grafting or transfer parasternal intercostal perforator flap even microsurgery with superficial circumflex iliac artery perforator (SCIP) skin flap to reconstruct the wound after resecting the lesion [6, 7, 10]
We reported the outcome of 15 patients who has giant keloid of chest and been treated with pre-expanded parasternal intercostal perforator flap after keloid resection in our hospital
Summary
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). Patients suffered from keloids often complain of unwanted symptoms such as pruritus, pain, skin infection and aesthetic problems, Nowadays, there are many therapeutic options for clinicians, including silicone-based therapy, intralesional steroids, cryosurgery, 5-fluorouracil, interferon, lasers, verapamil, radiotherapy and surgery [3,4,5]. Chest keloid is common in clinical practice. Some small keloids are round and oval.
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