The keloid triad hypothesis (KTH): a basis for keloid etiopathogenesis and clues for prevention

Abstract

The basis of keloid formation and its subsequent behavior, the very high incidence of recurrence after resection, and other forms of treatment are not fully understood. Keloids still remain a dilemma in plastic surgery. Analyzing the etiopathogenesis of keloids in a large number of patients in Ghana and in Poland led to a concept of keloid triad hypothesis (KTH). This is defined as a group of three etiologic factors which must simultaneously coexist and interact for keloids to form. The etiological factors are: genetic links; bacterial, viral or any type of infective agent; type of surgery - sutures, tension of suture lines, location of sutures in relationship to the body skin lines of tension; etc. At least three of these factors must be present, inter-correlate, in order to form a keloid. These factors have been sub-divided into two groups - major (or main) and minor (or auxiliary) and are analyzed in this paper. In each situation at least one major factor must be present in order for a keloid to form.