Dermal Matrix-Assisted Reconstruction After Keloid Excision: Long-Term Outcomes of a Combined Therapeutic Protocol.

Abstract

Extensive keloids represent a major therapeutic challenge due to their high propensity for recurrence and their functional, aesthetic, and psychological impact. Surgical excision alone is associated with a high recurrence rate ranging from 40% to 100%. The use of a dermal regeneration matrix after excision, in combination with intralesional corticosteroid injections, has emerged as a promising alternative. This combined approach may improve healing quality and reduce recurrence, particularly in large or complex lesions. The objective of this study was to evaluate the effectiveness of this multimodal treatment protocol. We conducted a retrospective study of extensive keloids treated between 2015 and 2023. All lesions were completely excised and covered with a dermal matrix, followed by secondary intention healing or split-thickness skin grafting. Monthly triamcinolone injections were administered postoperatively. The primary outcome measure was the absence or significant reduction of recurrence at the end of the follow-up period. In a cohort of 66 keloids with a median follow-up of 4.15 years, this combined therapeutic approach achieved a 65% success rate. Keloids covered with both dermal matrix and skin grafting had a significantly reduced risk of recurrence ( P < 0.01). However, donor site keloid formation occurred in 20% of cases. This combined approach offers an effective solution for extensive keloids. Skin grafting appears to reduce the risk of recurrence but carries a nonnegligible risk of keloid formation at the donor site. Randomized prospective studies are needed to further validate these findings and optimize patient selection.