title: Forty-five cases of chest keloids treated with subcutaneous super-tension-reduction suture combined with postoperative electron-beam irradiation.
abstract: BACKGROUND
  Chest keloids are challenging to surgeons because of their high recurrence rate.
  
  
  OBJECTIVE
  To investigate the effectiveness of the subcutaneous super-tension-reduction suture technique with postoperative electron-beam irradiation in the treatment of chest keloids.
  
  
  METHODS
  Forty-five patients with chest keloids underwent excision. To minimize the wound-closing tension, subcutaneous super-tension-reduction suture was used. The maximum tension reduction was placed on both dermis and subcutaneous tissue, which were far away from the incision. The consequence of such suturing was that the wound edges were moved centrally to elevate them like a bump after tying the buried knot. All patients received fractionated electron-beam radiation therapy starting within 24 hours after surgery, in a 5-Gy dose daily for 3 to 4 consecutive days, to a total dose of 15 to 20 Gy.
  
  
  RESULTS
  The wounds healed primarily in all 45 cases. The bump at the incision began to flatten out after 2 to 3 months and was almost completely flat by 12 months postoperatively. Only 1 case of relapse (2.2%) was observed within 2 years of follow-up examination.
  
  
  CONCLUSIONS
  The use of subcutaneous super-tension-reduction suture after chest keloids excision can greatly decrease tension on the dermis and the subcutaneous tissue and can, in combination with postoperative electron-beam irradiation, decrease the rate of relapse.
authors.affiliation: *All the authors are affiliated with Department of Plastic and Reconstructive Surgery, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
authors.forename: Lian-Zhao
authors.initials: LZ
authors.lastname: Wang
authors.forename: Jin-Ping
authors.initials: JP
authors.lastname: Ding
authors.forename: Ming-Yong
authors.initials: MY
authors.lastname: Yang
authors.forename: Bo
authors.initials: B
authors.lastname: Chen
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D005260:Female; D006801:Humans; D007627:Keloid / Q000209:etiology / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011879:Radiotherapy Dosage; D013536:Suture Techniques; D013537:Sutures; D013909:Thorax; D016896:Treatment Outcome