Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 26, 2022; 10(18): 6032-6038
Published online Jun 26, 2022. doi: 10.12998/wjcc.v10.i18.6032
Scar-centered dilation in the treatment of large keloids
Min Wu, Jie-Yu Gu, Ran Duan, Bo-Xuan Wei, Feng Xie
Min Wu, Jie-Yu Gu, Ran Duan, Bo-Xuan Wei, Feng Xie, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, Shanghai 200011, China
Author contributions: Xie F designed this retrospective study; Wu M wrote the manuscript; Gu JY, Duan R, and Wei WX were responsible for sorting the data.
Institutional review board statement: This study was approved by the Shanghai Ninth People’s Hospital Institutional Review Board.
Informed consent statement: All study participants, or their legal guardian, provided informed written consent prior to study enrollment.
Conflict-of-interest statement: The authors report no conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Feng Xie, MD, Associate Chief Physician, Department of Plastic and Reconstructive Surgery, Shanghai Ninth People’s Hospital, Shanghai JiaoTong University School of Medicine, No. 639 Zhizaoju Road, Shanghai 200011, China. xiefengdr@163.com
Received: January 10, 2022
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
Abstract
BACKGROUND

Hypertrophic scars and keloid treatment is a major problem in plastic surgery. While small keloids can be treated with resection followed by radiotherapy, large keloids require treatment with a tissue expander. Conventional methods increase the need for auxiliary incisions, causing new scar hyperplasia.

AIM

To introduce a new method for the treatment of keloids with an expander.

METHODS

Between 2018 and 2021, we performed surgeries to treat large keloids in nine patients with a two-stage approach. 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. To accomplish this, an incision was made along the scar boundary to avoid making a new surgical incision and creating new scars. Superficial radiotherapy was then performed postoperatively.

RESULTS

Two patients had anterior chest keloids. After treatment, the anterior chest incision was broken repeatedly and then sutured again after debridement. It healed smoothly without scar hyperplasia. Keloids were successfully removed in 7 patients without recurrence.

CONCLUSION

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. The treatment is effective, providing new insights and strategies for the treatment of similar large-area keloid and hypertrophic scar cases in the future.

Keywords: Expander; Keloids; Superficial radiotherapy; Intrascar incision; Treatment

Core Tip: This paper introduces a new method for the treatment of keloids with an expander. 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.