Can full thickness skin grafting be a cost effective alternative to dermal substitutes for keloid management? A case report

Abstract

Keloids are always challenging to manage due to their high chances of recurrence and poorly understood pathophysiology. Various modalities have been described, to be used either alone or in combination. We opted to look for a cost effective solution, that was along the lines of the research done by Nguyen et al using a reconstruction that provides for a dermal component while avoiding a second procedure. Here, we present the management of a helical rim keloid by complete excision and reconstruction with a full-thickness skin graft to create a neo-dermis at the site of the defect. A 28 year old lady of Indian ethnicity presented with a mass lesion over right ear lobe since about one year, approximately measuring 6×2 cm. It was associated with occasional pruritis and there was a history of trauma to ear lobe about 1-2 months before noticing the lesion. On examination, a single, firm, well- circumscribed, non-tender mass was noted extending over the posterior and superior aspect of the helix of right ear. After routine preoperative evaluation, the patient was taken up for elective surgery where the keloid was excised with de-epithelization of 2mm margin and a full thickness skin graft harvested from the groin of size 3×2 cm was used to cover the defect. Postoperatively, the patient had an uneventful recovery and good cosmetic outcome was achieved. We found this to be an economically feasible and aesthetically superior alternative to reconstruction using a dermal substitute.