Long-Term Outcome of Anterior Chest Keloid Excision Using Intercostal Artery Perforator Propeller Flaps

Abstract

Background: The chest, with its high skin tension, is prone to keloids and has a high relapse rate. Surgical excision of keloids combined with radiation therapy significantly reduces the recurrence rate. For larger chest keloids (3-10 cm), intercostal artery perforator propeller flap can be used to reduce tension. However, there is a lack of reports of long-term complications of this treatment.

Methods: The keloid excision using intercostal artery perforator propeller flap was performed for patients with anterior chest keloid between Oct 2018 and Aug 2022. Then radiation therapy was given in 6 Gy each time in 3 fractions over 3 days (electron beam irradiation) for a total dose of 18 Gy. All patients were followed up for at least 24 months. The complications were recorded and analyzed.

Results: A total of 15 patients with anterior chest keloid underwent surgery and radiation therapy. Satisfactory aesthetic outcomes were achieved. The recurrence rate was 0%. The major complication observed in our patients was a hypertrophic scar (86.7%), followed by hyperpigmentation (13.3%).

Conclusions: The major complication of our patients is the hypertrophic scar, followed by hyperpigmentation. Patients should be fully informed of the risk of this long-term complication (hypertrophic scar) preoperatively.

Level of evidence iv: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Keywords: Chest; Complication; Intercostal artery perforator propeller flap; Keloid; Radiation therapy.