Background: Very large keloids are difficult to completely resect and the resulting wounds are difficult to close directly. Skin grafting tends to generate secondary contractures, and circular keloids can recur at the margins of the grafted skin.

Objectives: We attempted to use perforator flaps to release tension on the recipient site. Here, we report our method of treating large keloids using internal mammary artery perforator (IMAP) flaps and a musculophrenic artery perforator (MPAP) flap.

Methods: Eleven patients (ten male and one female; average age, 38.1 years) with large/severe keloids located on the anterior chest wall underwent reconstructive surgery using 10 IMAP and 1 MPAP pedicled propeller flaps and post-operative radiation therapy. All cases were followed for over 36 months. Donor site position, perforator pedicle, flap size, and the angle of flap rotation were analyzed, and any complications and/or recurrence noted. All cases received postoperative radiation therapy (20 Gy/4 fractions/4 days) and silicone tape fixation at both the donor and recipient sites. Postoperative course, keloid recurrence at the recipient site, and keloid generation at the donor site were evaluated.

Results: For seven cases, the postoperative course after silicone tape fixation alone was uneventful. Recurrence at the recipient sites was observed in four cases; however, recurrence was inhibited by steroid tape. No new keloids occurred at the donor site.

Conclusion: Releasing the tension around the recipient site using skin flaps that can be expanded gradually over time prevents the development and recurrence of keloids. However, it should be noted that the donor sites should also be managed carefully using postoperative radiotherapy and tape fixation.

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