Objective: To investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients.
Methods: Between January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation.
Results: All IMAP propeller flaps survived well, and the donor site healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching were relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment.
Conclusion: IMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.
目的: 探讨胸廓内动脉穿支（internal mammary artery perforator，IMAP）螺旋桨皮瓣修复结合术后放射治疗女性患者胸部瘢痕疙瘩的疗效。.
方法: 2015 年 1 月—2016 年 12 月，收治 15 例胸部瘢痕疙瘩女性患者。年龄 28～75 岁，平均 45.2 岁。患者瘢痕疙瘩病史 1～28 年，中位时间 6 年。病因：毛囊炎致继发性瘢痕疙瘩 7 例，心脏手术后 4 例，皮肤擦刮伤 2 例，蚊虫叮咬 1 例，原因不明 1 列。瘢痕疙瘩范围为 5 cm×3 cm～17 cm×6 cm。采用 IMAP 螺旋桨皮瓣修复胸部瘢痕疙瘩切除后创面（皮瓣切取范围 7 cm×5 cm～14 cm×8 cm）；供区均直接缝合。术后均行放射治疗。.
结果: 术后所有 IMAP 螺旋桨皮瓣均成活良好，供区切口均Ⅰ期愈合。15 例患者均获随访，随访时间 12～24 个月，平均 16 个月。无毛细血管扩张或切口裂开发生，随访期间未见放射相关的癌变。患者对术后乳房外形、对称性均较满意。13 例（86.7%）瘢痕疙瘩区域痒痛症状缓解，供受区瘢痕未见明显增生复发；2 例复发（13.3%），继续瘢痕疙瘩的保守治疗。.
结论: 采用 IMAP 螺旋桨皮瓣修复女性患者胸壁瘢痕疙瘩切除后创面，可更好地保留乳房外形；联合术后早期放射治疗可有效降低瘢痕疙瘩复发率，效果满意。.
Keywords: Keloid; internal mammary artery perforator; propeller flap; radiotherapy.