Papers of The 4th Japan Scar Workshop

23. Usefulness and problems of flap surgery for keloids

Masayo Aoki, Satoshi Akaishi, Simpei Ono, Itaru Iwakiri, Rei Ogawa, Hiko Hyakusoku
Department of Plastic and Reconstructive Surgery, Nippon Medical School, Tokyo, Japan

OBJECTIVE: For Surgical treatment of keloids, excision and simple suture with post-operative radiation therapy are considered to be most effective. However, it is sometimes difficult to do direct suture and we have to consider skin grafting or flap transfer. We report the effect of flap surgery after keloid excision with post-operative irradiation.
METHODS: Four patients with keloids were treated with skin flap and post-operative radiation therapy from 2001 to 2008. We examined their postoperative course.
RESULTS: The age range was 27-62 (average 43), and the follow-up period was 14-54 (average 25.5) months. All patients were treated by post-operative radiation therapy (15Gy/3fractions/3days or 20Gy/4fractions/4days). The results of three patients were excellent or good (75%), but that of one patient was poor because of the recurrence of keloids (25%).
DISCUSSION: In flap surgery for keloids, it is important to suppress the recurrence of keloids from the edge of the flap and donor site. The flap should be large enough not to cause any tension, while it is necessary to avoid the tension of the donor site, also to exclude the areas of predilection.
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