Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6032
Peer-review started: January 10, 2022
First decision: February 14, 2022
Revised: February 21, 2022
Accepted: April 20, 2022
Article in press: April 20, 2022
Published online: June 26, 2022
Processing time: 157 Days and 19.2 Hours
Current treatment modalities are classified as either conservative or surgical. Conservative treatments include intra-scar injection of anti-scar drugs, laser, external force compression, and radiotherapy, although complete curation is often not achieved. While small keloids can be directly resected followed by radiotherapy, large keloids cannot be directly resected; they require treatment with a tissue expander.
We present a new method, keloid-centered expansion keloid-centered expansion.
After treatment with a single linear incision, the surgical incision was located on the keloids. Thus, because there was no additional auxiliary incision, the possibility of a new keloid was reduced.
In the first stage, an intrascar incision was made in the keloid, and a customized expander was implanted under the keloid and the surrounding normal skin. A period of 3-6 mo was allowed for skin expansion. In the second stage, after the initial incision healed, a follow-up surgery was performed to remove the expander, resect the keloid, and repair the expanded skin flap.
Keloids were successfully removed in seven patients using this approach without recurrence. In two patients who had anterior chest keloids, wound healing was prolonged. However, after debridement and re-suturing, the wound healed smoothly without scar hyperplasia.
This method was performed through a keloid incision and with a custom expander embedded. After full expansion, the keloid was directly resected using a linear suture, which avoids new surgical incisions and scars and can successfully remove large-area keloids.
Keloid treatment, especially large keloids, has always been a major problem for surgeons, and this study provides a solution for this problem, which is likely applicable for treating keloids of all sizes and for treating other hypertrophic scars as well.