A 40-year-old man has a large keloid on the chest wall after a previous sternotomy. Which of the following treatment approaches is MOST effective for preventing recurrence after keloid excision?

• A Wide local excision alone with primary closure
• B Excision with Z-plasty to redistribute tension
• C Nd:YAG laser ablation without surgery
• D Excision followed by postoperative radiotherapy or intralesional steroid injection ✓

Explanation

Keloid recurrence after simple excision alone is extremely high (45-100%), especially on the chest wall. Combining excision with adjuvant therapy — postoperative radiotherapy (within 24 hours of excision) or intralesional corticosteroid injection (triamcinolone) — significantly reduces recurrence. Pressure therapy and silicone gel sheeting are also adjuncts. Excision alone or Z-plasty without adjuvant treatment carries unacceptably high recurrence rates in keloid-prone sites.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.