Abstract: Principles and Algorithm for the Microsurgical Treatment of Unstable Keloids on the Trunk after Burn Injury (Plastic Surgery The Meeting)

Monday, September 26, 2016: 11:35 AM

Mathias Tremp, MD , Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Basel, Switzerland

Shaoqing Feng, MD, PhD , Dept. of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Dirk J. Schaefer, MD , Plastic, Reconstructive, Aesthetic and Hand Surgery, Basel University Hospital, Basel, Switzerland

Peiru Min, MD , Dept. of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Daniel Kalbermatten, MD, PhD , Plastic, Reconstructive, Aesthetic Surgery and Hand Surgery, University Hospital Basel, Basel, Switzerland

Yixin Zhang, MD, PhD , Dept. of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China

Presentation PDF file

Introduction

Unstable keloids are one of the most frustrating clinical problems in wound healing and the pathogeneses remains largely unknown.(1) To date, little is known in the literature about the microsurgical management of unstable and middle-sized keloids on the trunk, and a clear consensus is lacking.(2) Perforator flaps are thin and pliable, have a robust blood supply, potentially release the scar-site tension effectively and may provide an outcome with well-matched color, thickness, and texture.(3, 4) In this study, we provide a versatile algorithm by using various pedicled and free perforator flaps for the treatment of keloids on the trunk.

Materials and Methods

Patients with a history of multiple treatments of middle-sized keloids on various regions of the trunk were included. Color Doppler ultrasound (CDU) and multidetector-row computed tomographic angiography (MDCTA) were performed preoperatively. Depending on the location of the keloid, the following flaps were used: superficial circumflex iliac artery perforator (SCIP) flap, internal mammary artery perforator (IMAP) flap, superior epigastric artery perforator (SEAP) flap, anterior intercostal artery perforator (AICAP) flap, deep inferior epigastric artery perforator (DIEP) flap and anterolateral thigh (ALT) flap.

Results

Between June 2013 to June 2015, 29 patients (15 male and 14 females) with a mean age of 41±15years were treated. Totally, we performed 5 free SCIP flaps, 2 pedicled SCIP flaps, 8 IMAP flaps, 6 SEAP flaps, 3 AICAP flaps, 4 DIEP flaps and 1 ALT flap. The mean flap size was 83±36cm² and the mean flap thickness was 14.8±5mm. One partial distal necrosis occurred after a pedicled AICAP reconstruction, which healed conservatively. After a mean follow-up of 5±3months, all surviving flaps showed excellent thickness, texture and color match. Importantly, there was no need for secondary debulking surgery. The donor site healed well after primary closure in all patients.

Conclusions

We successfully applied various free and pedicled perforator flaps for the treatment of unstable keloids on the trunk. Based on our experience, we provide a useful and reliable algorithm in order to achieve the best possible outcome.

28755 Principles and Algorithm for the Microsurgical Treatment of Unstable Keloids on the Trunk after Burn Injury