Abstract
Patients suffering from keloid scarring often face debilitating functional and psychosocial symptoms. The complex pathophysiology of keloids necessitates a patient-centered therapeutic regimen to optimize patient satisfaction and disease resolution. This is especially challenging for patients with major keloid scars that once surgically resected, leave a defect that cannot be closed primarily. The authors intended to identify existing therapeutic regimens reported for the treatment of major keloids and detail the clinical and patient-satisfaction outcomes for those approaches. A systematic review and meta-analysis was designed in accordance with Preferred Reporting Items for Systematic reviews and Meta-analyses guidelines, querying 2 databases along with a manual search for relevant literature. This review identified 10 studies, totaling 244 patents. All patients underwent surgical resection of their keloid. Subsequent therapeutic regimens included a variety of coverage techniques, including skin grafts, perforator flaps, closure with secondary intention, and skin substitute placement. Additionally, there were multiple adjuvant therapies utilized such as radiotherapy and steroids. The overall keloid recurrence rate was 21%. Patients who received wound coverage had a lower rate of keloid recurrence compared with those treated by secondary intention. When available, patients receiving local flap coverage plus adjuvant radiotherapy were found to have significantly lower keloid recurrence rates and higher patient satisfaction. Although these findings support surgical excision and radiation therapy as the mainstay treatment for major keloids, the efficacy of various wound coverage options, especially when local perforator flaps are not available, requires continued investigation. A gap exists on guidelines for postoperative adjuvant therapies.