Effectiveness of internal mammary artery perforator propeller flap repair combined with radiotherapy for chest keloid in female patients_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LIU Yong ¹ , XIAO Haitao ¹ , LIU Xiaoxue ¹ , CAO Chang ¹ , WU Junliang ¹ , YAO Bing ² , CHEN Yuan ³ ,  XU Xuewen ¹

1. Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
2. Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China;
3. West China School of Stomatology, Sichuan University, Chengdu Sichuan, 610041, P.R.China;

Corresponding author：

XU Xuewen, Email: xxw_0826@163.com

Keywords：

Keloid; internal mammary artery perforator; propeller flap; radiotherapy

DOI：

10.7507/1002-1892.201803004

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ObjectiveTo investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients.MethodsBetween January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation.ResultsAll IMAP propeller flaps survived well, and the donor sites healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment.ConclusionIMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.

Citation： LIU Yong, XIAO Haitao, LIU Xiaoxue, CAO Chang, WU Junliang, YAO Bing, CHEN Yuan, XU Xuewen. Effectiveness of internal mammary artery perforator propeller flap repair combined with radiotherapy for chest keloid in female patients. Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(9): 1196-1200. doi: 10.7507/1002-1892.201803004 Copy

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13.	Wolfram D, Tzankov A, Pulzl P, et al. Hypertrophic scars and keloids—a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg, 2009, 35(2): 171-181.
14.	Leer JW, van Houtte P, Davelaar J. Indications and treatment schedules for irradiation of benign diseases: a survey. Radiother Oncol, 1998, 48(3): 249-257.
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1. Chike-Obi CJ, Cole PD, Brissett AE. Keloids: pathogenesis, clinical features, and management. Semin Plast Surg, 2009, 23(3): 178-184.
2. Akaishi S, Akimoto M, Ogawa R, et al. The relationship between keloid growth pattern and stretching tension: visual analysis using the finite element method. Ann Plast Surg, 2008, 60(4): 445-451.
3. Mustoe TA, Cooter RD, Gold MH, et al. International clinical recommendations on scar management. Plast Reconstr Surg, 2002, 110(2): 560-571.
4. Ogawa R, Mitsuhashi K, Hyakusoku H, et al. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg, 2003, 111(2): 547-553.
5. Takeuchi M, Sakurai H. Internal mammary artery perforator flap for reconstruction of the chest wall. J Plast Surg Hand Surg, 2013, 47(4): 328-330.
6. Koulaxouzidis G, Orhun A, Stavrakis T, et al. Second intercostal internal mammary artery perforator (IMAP) fasciocutaneous flap as an alternative choice for the treatment of deep sternal wound infections (DSWI). J Plast Reconstr Aesthet Surg, 2015, 68(9): 1262-1267.
7. Ogawa R, Ono S, Akaishi S, et al. Reconstruction after anterior chest wall keloid resection using internal mammary artery perforator propeller flaps. Plast Reconstr Surg Glob Open, 2016, 4(9): e1049.
8. Schmidt M, Aszmann OC, Beck H, et al. The anatomic basis of the internal mammary artery perforator flap: a cadaver study. J Plast Reconstr Aesthet Surg, 2010, 63(2): 191-196.
9. 蔡景龙, 张宗学. 现代瘢痕治疗学. 北京: 人民卫生出版社, 1998: 166-167.
10. Ji J, Tian Y, Zhu YQ, et al. Ionizing irradiation inhibits keloid fibroblast cell proliferation and induces premature cellular senescence. J Dermatol, 2015, 42(1): 56-63.
11. Ogawa R, Yoshitatsu S, Yoshida K, et al. Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis Plast Reconstr Surg, 2009, 124(4): 1196-1201.
12. Sakamoto T, Oya N, Shibuya K, et al. Dose-response relationship and dose optimization in radiotherapy of postoperative keloids. Radiother Oncol, 2009, 91(2): 271-276.
13. Wolfram D, Tzankov A, Pulzl P, et al. Hypertrophic scars and keloids—a review of their pathophysiology, risk factors, and therapeutic management. Dermatol Surg, 2009, 35(2): 171-181.
14. Leer JW, van Houtte P, Davelaar J. Indications and treatment schedules for irradiation of benign diseases: a survey. Radiother Oncol, 1998, 48(3): 249-257.
15. Kim S, Choi TH, Liu W, et al. Update on scar management: guidelines for treating Asian patients. Plast Reconstr Surg, 2013, 132(6): 1580-1589.

Chinese Journal of Reparative and Reconstructive Surgery

Effectiveness of internal mammary artery perforator propeller flap repair combined with radiotherapy for chest keloid in female patients

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