Aesthetic Plastic Surgery

, Volume 42, Issue 1, pp 304–309 | Cite as

Keloid Skin Flap Retention and Resurfacing in Facial Keloid Treatment

  • Shu Liu
  • Weizhong Liang
  • Kexin Song
  • Youbin WangEmail author
Original Article Special Topics



Facial keloids commonly occur in young patients. Multiple keloid masses often converge into a large lesion on the face, representing a significant obstacle to keloid mass excision and reconstruction. We describe a new surgical method that excises the keloid mass and resurfaces the wound by saving the keloid skin as a skin flap during facial keloid treatment.


Forty-five patients with facial keloids were treated in our department between January 2013 and January 2016. Multiple incisions were made along the facial esthetic line on the keloid mass. The keloid skin was dissected and elevated as a skin flap with one or two pedicles. The scar tissue in the keloid was then removed through the incision. The wound was covered with the preserved keloid skin flap and closed without tension. Radiotherapy and hyperbaric oxygen were applied after surgery. Patients underwent follow-up examinations 6 and 12 months after surgery.


Of the 45 total patients, 32 patients were cured and seven patients were partially cured. The efficacy rate was 88.9%, and 38 patients (84.4%) were satisfied with the esthetic result.


We describe an efficacious and esthetically satisfactory surgical method for managing facial keloids by preserving the keloid skin as a skin flap.

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


Facial keloid Keloid skin flap Radiotherapy 



The authors have indicated no significant interest with commercial supporters.

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MOV 107265 kb)

Supplementary material 2 (MOV 72577 kb)

Supplementary material 3 (MOV 59621 kb)


  1. 1.
    Wolfram D, Tzankov A, Pülzl P et al (2009) Hypertrophic scars and keloids—a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg 35:171–181CrossRefPubMedGoogle Scholar
  2. 2.
    Kim K, Son D, Kim J (2015) Radiation therapy following total keloidectomy: a retrospective study over 11 years. Arch Plast Surg 42(5):588–595CrossRefPubMedPubMedCentralGoogle Scholar
  3. 3.
    Lindsey WH, Davis PT (1997) Facial keloids. A 15-year experience. Arch Otolaryngol Head Neck Surg 123(4):397–400CrossRefPubMedGoogle Scholar
  4. 4.
    Donkor P (2007) Head and neck keloid: treatment by core excision and delayed intralesional injection of steroid. J Oral Maxillofac Surg 65(7):1292–1296CrossRefPubMedGoogle Scholar
  5. 5.
    Lee Y, Minn KW, Baek RM et al (2001) A new surgical treatment of keloid: keloid core excision. Ann Plast Surg 46(2):135–140CrossRefPubMedGoogle Scholar
  6. 6.
    Pestarardo CM, Cordero A Jr, Ansorena JM et al (1995) Acne keloidalis nuchae. Tissue expansion treatment. Dermatol Surg 21(8):723–724CrossRefGoogle Scholar
  7. 7.
    Berman B, Maderal A, Raphael B (2017) Keloids and hypertrophic scars: pathophysiology, classification, and treatment. Dermatol Surg 43:S3–S18CrossRefPubMedGoogle Scholar
  8. 8.
    Gauglitz GG, Korting HC, Pavicic T et al (2011) Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 17(1–2):113–125PubMedGoogle Scholar
  9. 9.
    Jacobsson F (1948) The treatment of keloid at radium-hemmet, 1921–1941. Acta Radiol 29(3):251–267CrossRefPubMedGoogle Scholar
  10. 10.
    Speranza G, Sultanem K, Muanza T (2008) Descriptive study of patients receiving excision and radiotherapy for keloids. Int J Radiat Oncol Biol Phys 71(5):1465–1469CrossRefPubMedGoogle Scholar
  11. 11.
    Malaker K, Vijayraghavan K, Hodson I et al (2004) Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol (R Coll Radiol) 16(4):290–298CrossRefGoogle Scholar
  12. 12.
    Sigaux N, Jacquemart M, Cousin AS et al (2017) Association of surgical excision and brachytherapy for the management of keloids. J Stomatol Oral Maxillofac Surg 118(3):161–166CrossRefPubMedGoogle Scholar
  13. 13.
    Guix B, Henríquez I, Andrés A et al (2001) Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys 50(1):167–172CrossRefPubMedGoogle Scholar
  14. 14.
    Ogawa R, Yoshitatsu S, Yoshida K et al (2009) Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis. Plast Reconstr Surg 124(4):1196–1201CrossRefPubMedGoogle Scholar
  15. 15.
    Gauglitz GG, Korting HC, Pavicic T, Ruzicka T, Jeschke MG (2011) Hypertrophic scarring and keloids: pathomechanisms and current and emerging treatment strategies. Mol Med 17(1–2):113–125PubMedGoogle Scholar
  16. 16.
    Ogama R, Akaishi S, Chenyu H et al (2011) Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nippon Med Sch 78:68–76CrossRefGoogle Scholar
  17. 17.
    Admas BB, Gloster HM (2002) Surgical pearl: excision with suprakeloidal flap and radiation therapy for keloids. J Am Acad Dermatol 47(2):307–309CrossRefGoogle Scholar
  18. 18.
    Araújo FM, Kondo RN, Minelli L (2013) Pyoderma gangrenosum: skin grafting and hyperbaric oxygen as adjuvants in the treatment of a deep and extensive ulcer. An Bras Dermatol 88:176–178CrossRefPubMedPubMedCentralGoogle Scholar
  19. 19.
    Ding Z, Tong WC, Lu XX et al (2014) Hyperbaric oxygen therapy in acute ischemic stroke: a review. Interv Neurol 2(4):201–211CrossRefPubMedPubMedCentralGoogle Scholar
  20. 20.
    Migita H, Yoshitake S, Tange Y et al (2016) Hyperbaric oxygen therapy suppresses apoptosis and promotes renal tubular regeneration after renal ischemia reperfusion injury in rats. Nephrourol Mon 8(1):e34421CrossRefPubMedPubMedCentralGoogle Scholar
  21. 21.
    Skeik N, Porten BR, Isaacson E et al (2015) Hyperbaric oxygen treatment outcome for different indications from a single center. Ann Vasc Surg 29(2):206–214CrossRefPubMedGoogle Scholar
  22. 22.
    Richards L, Lineaweaver WC, Stile F et al (2003) Effect of hyperbaric oxygen therapy on the tube pedicle flap survival in a rat model. Ann Plast Surg 50(1):51–56CrossRefPubMedGoogle Scholar
  23. 23.
    Xiao YD, Liu YQ, Li JL et al (2015) Hyperbaric oxygen preconditioning inhibits skin flap apoptosis in a rat ischemia-reperfusion model. J Surg Res 199(2):732–739CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC and International Society of Aesthetic Plastic Surgery 2017

Authors and Affiliations

  • Shu Liu
    • 1
  • Weizhong Liang
    • 2
  • Kexin Song
    • 3
  • Youbin Wang
    • 3
    Email author
  1. 1.Meitan General Hospital Affiliated to North China University of Science and TechnologyBeijingChina
  2. 2.Department of Plastic SurgeryMeitan General HospitalBeijingChina
  3. 3.Department of Plastic SurgeryPeking Union Medical College HospitalBeijingChina

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