Impact of internal mammary artery perforator propeller flaps combined with radiotherapy in the treatment of large chest keloids: Our experience

Abstract

Background: Keloids are benign skin hyperplasias but have a tumor-like appearance. Clinical management of keloids remains challenging.

Aims: We retrospectively evaluated the safety and efficacy of internal mammary artery perforator propeller flaps combined with timely radiotherapy in the treatment of large chest keloids.

Methods: From June 2017 to May 2020, 25 patients with large chest keloids (average size 4.82 cm ± 2.53 cm × 9.04 cm ± 4.86 cm) who received both radiotherapy and internal mammary artery perforator flaps transplantation in our department were included. After surgical removal of the keloids, various propeller flaps based on the unilateral internal mammary artery were designed and applied to repair the defects. Timely and full-dose radiotherapy was performed for these patients after the operation.

Results: After keloid resection, the dimensions of the defect area were 3 cm-15 cm × 4 cm-25 cm, and the sizes of the flaps were 3 cm-16 cm × 4 cm-27 cm. For all 25 patients, the flaps survived, and the incisions healed in one stage. During the follow-up (median 18 months), no local recurrence was observed, and the itching and pain symptoms in the scar area were significantly relieved. Both physicians and patients were satisfied with the results.

Conclusions: The application of internal mammary artery perforator propeller flaps combined with radiotherapy in the treatment of chest keloids can effectively reduce the recurrence of keloids and relieve the related symptoms. It also has advantages including minimized donor site damage, short operation time and speedy postoperative recovery, suggesting its great clinical value.

Keywords: internal mammary artery perforator flaps; keloids; radiotherapy; reconstruction; scar management.

Figure 1

Surgical procedures. (A) Measured and designed the flap according to the shape and size of the defect. (B,C) The flap was dissected and the vascular pedicle was carefully freed to ensure rotation. (D,E) The flap was rotated and covered the defect without much tension.

Figure 2

A 46-year-old female suffering from anterior chest wall keloids. (A) The position of the perforators was detected, and the resection areawas marked. (B) A defect of 5 cm × 7 cm is left after the resection. The flap was designed, and the vessel was detected repeatedly during detachment of the flap. (C) The defect was covered without tension. (D) 18 months after the operation.

Figure 3

A 57-year-old male suffering from a large anterior chest wall keloid that had recurrent ulceration. (A) The position of the perforators was detected, and the resection area was marked. (B) The size of the upper portion of the defect area that could not be sutured by primary closure was 6 cm × 12 cm and was left after resection. (C) An IMAP flap was applied to cover the defect, and the skin incision was closed without much tension. (D) 15 months after the operation.

Figure 4

A 60-year-old female suffering from an anterior chest wall keloid. (A) The bilateral IMAP was detected, and its position was marked. (B) A left side IMAP flap was chosen to cover the defect. (C) 12 months after the operation.