Full-thickness Skin Grafting With Marginal Deepithelialization of the Defect for Reconstruction of Helical Rim Keloids

Abstract

Excising a keloid from the helical rim generally results in a narrow defect with exposed cartilage. Skin grafting is a surgical method with a lowest recurrence rate for keloid treatment. Full-thickness skin grafting may produce an excellent cosmetic outcome, but is generally considered too unreliable over a poorly vascularized defect with exposed cartilage. Adding a new healthy bed with rich vascularity on the periphery will increase the probability of the entire graft surviving via the bridging phenomenon. We report full-thickness skin grafting using a marginal deepithelialization technique for treatment of helical rim keloids. After keloid excision, the surrounding normal skin was deepithelialized 2 to 3 mm wide over the defect border, followed by full-thickness skin grafting. All grafts survived completely. None of the keloids recurred, and they all showed an excellent aesthetic result during the follow-up period from 9 months to 6 years.

The management of helical rim keloids with excision, split thickness skin graft and intralesional triamcinolone acetonide

“…[56] Helical rim keloids can result from a variety of causes involving deep dermal injury, with the most common being ear piercings, post-elective surgery, acne, trauma or burns. [3] Increasing tension placed upon the lesion in certain sites and orientations, and the presence of infection and foreign bodies, may augment the risk of keloid formation. Keloid can develop at any age, but tends to be most prevalent in individuals aged between 10 and 30 years.…”

“…[3] Split-thickness skin grafts may, however, produce suboptimal cosmetic results due to its thinness and shrinking, although it shows excellent graft take. Full-thickness skin grafting may produce an excellent cosmetic outcome when the donor skin has a similar colour, but is generally considered too unreliable over the poorly vascularised perichondrial bed.…”

“…The lack of an adequate vascular supply on a narrow helical defect with exposed cartilage may result in failure of full-thickness skin grafts. [3] In this study, the size of the lesions precluded the use of full thickness skin grafts. The reported recurrence rate after skin grafting has ranged from 0% to 9% and is the lowest among all of the surgical techniques used; 12.5% after keloid core excision and the use of a rind flap, 44% after local excision and 50% after the use of a keloid fillet flap.…”

“…The reported recurrence rate after skin grafting has ranged from 0% to 9% and is the lowest among all of the surgical techniques used; 12.5% after keloid core excision and the use of a rind flap, 44% after local excision and 50% after the use of a keloid fillet flap. [3]…”

“…[12] Keloids of the helical rim are disfiguring and a cosmetically acceptable reconstruction is difficult especially in moderate to large sized lesions because the helical rim is a 3-dimensional structure with curved and thin cartilage. [3] We report our experience in the management of moderate (4-10 cm) and large (>10 cm) helical rim keloids in five patients.…”