LAUSR

For those patients with keloids and active infection, surgical excision is the most appropriate approach because the active infected lesions can grow rapidly. After the removal of the entire lesion, the wound is usually repaired with direct sutures, skin grafts, or skin flap. Extra tension because of direct sutures would cause recurrence, involuting the dermis using a specific absorbable suture could generally reduce the tension. However, it is not suitable for massive lesions, particularly those in the chest, because breathing pain is frequently unbearable. Besides, skin grafts or flaps were usually used to repair wounds, but it would cause damage to normal tissue and often require additional radiation doses in the donor area. Therefore, we introduce a new technique to reduce the tension by tightening the fascia layer, wherein active muscle-derived tension stimulation is blocked during the healing process. Moreover, all large incisions could be successfully sutured without skin grafting or flaps. We have used this therapeutic modality for 15 patients with keloids and achieved satisfactory results. Technique and Results Before surgery, the incision was marked, and 2 mL of 1% lidocaine with 1:400,000 adrenaline was administered for local anesthesia. The skin surface was cut along the incision, down to the subdermal vascular network level. First, the focus core, including infected tissue, was peeled off the keloid skin using a No. 11 blade, retaining an approximately 1-mm thick epidermis (Figure 1). For large lesions wider than 5 cm, the distal end was further thinned, to ensure no clamping of the epidermis during the process that would help insure wound healing well. Then, bipolar electrocoagulation was applied for intraoperative hemostasis. The needle with PDS II (polydioxanone) synthetic absorbable suture suture (ETHICON Johnson & Johnson, NJ) (3-0 to 4-0 according to the tension) entered the up layer of superficial fascia 3 to 4 mm from the wound edge and exited the adjacent point before advancing the needle to the next marked suture interval. Next, the suture depth penetrated the deep layer of the fascia without reaching the muscles, after sewing to the opposite edge, return to the