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

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.

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.

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%).

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.

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