Craniofacial Keloid Management Using Split-Thickness Skin Grafting and Postexcisional Adjuvant Brachytherapy

Keloids are fibroproliferative scars that can range from mildly abnormal wound healing to significant and excessive outgrowth of scar beyond the area of the original wound. They may be associated with microtrauma, and surgery is a well-recognized risk factor in patients with a predisposition to keloid scars formation. Treatment options range from minimally invasive medical therapy to surgical excision of the keloid with various adjuvant therapies. In this paper, the authors present a case of craniofacial keloid treated with surgical excision, split-thickness skin graft, and adjuvant brachytherapy. Patient comorbidities included diabetes mellitus and tobacco use, and preoperative optimization included smoking cessation and efforts toward glycemic management. Given that keloids secondary to surgical wounds tend to most commonly occur at the skin edges, brachytherapy was applied at the wound margins to reduce the risk of recurrence. Brachytherapy allowed targeted radiation application while avoiding radiation to deeper critical neck structures. Notably, the split-thickness skin graft remained viable despite exposure to adjuvant brachytherapy. This demonstrates the feasibility of combining graft reconstruction with targeted postoperative radiation in complex craniofacial keloid management. Postoperative results at 2 years demonstrated no recurrence in the treated area, thus decreasing the overall keloid burden in the patient and resulting in acceptable cosmesis. In addition, the patient reported satisfaction with the outcomes.