Treatment of Keloid by Implantation of Tissue Expander beneath the Keloid Tissue.

Keloids always remain a great challenge due to limited surgical treatment options. Most treatments e.g. surgery, drug therapy, radiotherapy, laser therapy, and cryotherapy for managing keloids have very limited effectiveness, for keloids grow slowly but progressively and the recurrence rate is inappreciably high. Skin expansion constitutes a potential treatment option in the treatment of large keloid. This study was intended to determine the clinical outcome of 'Tissue Expander beneath the Keloid Surgery' for repair of wound formed as a result of excision of relatively large keloids. This retrospective study was done in the Department of Dermatology and Venereology of Nantong University-affiliated Hospital, China. Using a quasi-experimental design, from August 2006 to August 2017, 75 keloids in 70 patients were implanted with tissue expanders, the capacity of which was 70-600ml. After 50-126 days of implantation, the intralesional excision with flap advancement surgery was carried out. During intraoperative period, keloid lesions were treated with beta methasone injection as 0.2ml per sq. cm of lesion and the total dose should not normally over 1-2ml per dose and postoperative superficial electron beam irradiation. Post-operative follow-up ranged from 12 to 50 months. All patients underwent keloid resection followed by radiation at postoperative day 1 and 8 with a total dose 16-18 Gy. The patient and observer scar assessment scales (POSAS) were used to evaluate changes in keloids pre- and post-operatively. Among 75 keloids, 71(94.7%) (Including 11 keloids combined with the infected site) demonstrated successful outcome, 4(5.3%) expanders in the chest failed. Infection occurred in 4(5.3%) keloids during expansion process which led to early removal of expander resulting in failure of the operation, while in the remaining 71 sites, the entire treatment process was successfully completed. Follow-up was done for more than 12 months, when 14 sites (all anterior chest) exhibited local recurrence. There was no recurrence in the 14 sites of pubic region. The total POSAS scores before surgery were 59.3±13.6 which significantly reduced to 17.7±9.1 after 12 months of surgery (p<0.001). Soft tissue expanders implantation beneath the keloid is one of the ideal methods to treat relatively large keloids, formed as a result of excision of relatively large keloids, provided the patients are carefully selected based on knowledge about possible complications.