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Men et al. Reconstruction of keloid defect with the rectus abdominis myocutaneous flap

range of distribution of perforating vessels to the integrity of one side of the rectus abdominis muscle is
abdominal skin, specific perforating vessels can be compromised, which to a certain degree damages the
selected according to the size of the chest wound and strength and integrity of the abdominal wall. Therefore,
its distance from the abdomen. for young male keloid patients, this surgical method is
not recommended, and is why all patients in this series
The rectus abdominis muscle is important in were women.
maintaining abdominal wall strength. Partial
preservation of this muscle therefore essential when (2) The rectus abdominis muscle flap is more suitable
designing the rectus abdominis myocutaneous flap. In for wound recovery following resection of a keloid
a report by Chen et al., [20] 8 patients underwent breast located in the middle or distal aspect of the chest.
reconstruction with the muscle-sparing TRAM flap. Of Secondary to limitations of the length of the pedicle,
these 8 patients, 2 experienced borderline necrosis it would be difficult to repair a keloid located in the
and subcutaneous fat liquefaction within zone IV of middle or proximal chest. Moreover, the subcutaneous
the flap, with healing following debridement. Although tissue of the flap is quite thick which provides a poor
partial skin flap necrosis is well-tolerated in breast match to tissue of the upper chest. In addition, the
reconstruction patients, it is problematic in keloid longer the pedicle required, the wider the dissection
treatment as it delays the initiation of postoperative must be, increasing the size of the donor site defect.
radiotherapy. This scenario also increases the risk for For patients who have demonstrated a propensity
keloid recurrence secondary to chronic inflammation. [21] towards keloid formation, the risk of postoperative
Abdominal wall strength is preserved and herniation is scar hyperplasia or additional keloid formation is even
prevented by saving the anterior sheath of the rectus greater. When a keloid in the middle or lower part of
abdominis muscle. the chest wall has been repaired with a myocutaneous
flap from the rectus abdominis muscle in the middle
The IMA perforator flap is another option for patients or upper abdomen, the postoperative incision will be
with keloids of the chest wall. Trauma to the abdominal located within the radiotherapy range, which is both
wall is minimized with this method as compared to the convenient for performing radiotherapy and reduces
rectus abdominis myocutaneous flap. Ogawa et al. [22] the extent of radiation damage to the normal tissue.
have reported use of this skin flap design in chest Therefore, it is recommended that a myocutaneous
wall keloid wound coverage. In their report, a skin flap flap of the rectus abdominis from the middle or upper
measuring 14 cm × 5 cm was designed based on the abdomen be used to repair the wound following keloid
dominant perforators of the IMA in the 6th, 7th, 8th and resection from the middle or lower chest.
9th intercostal spaces. In the current study, however,
the borders of the keloids extended more distally. (3) Although a rectus abdominis myocutaneous
The perforators were difficult to identify by Doppler flap can provide a large portion of tissue for wound
ultrasound secondary to the overlying keloid mass. repair, the amount of tissue that this approach can
These perforators would also have been damaged provide is nevertheless limited. When the wound
following resection of the, and therefore would have following resection exceeds the amount of tissue that
been unsuitable for use as a flap pedicle. The rectus can be provided by the flap, one must additionally
abdominis myocutaneous flap is a more appropriate consider other methods or the use of multiple flaps in
choice in this situation for very large keloids which combination for repair.
cover the inferior chest and upper abdominal wall.
Authors’ contributions
Although use of the rectus abdominis myocutaneous Manuscript’s preparation: Q.C. Men, S. Liu
flap from the abdominal wall for wound repair following Manuscript’s review: Y.B. Wang, Z. Lin, L. Xiao
keloid resection can provide a reliable blood supply Concept design: Y.B. Wang
and good soft tissue match, the extent of surgical Literature search: K.X. Song, L. Hao, X.H. Dong
trauma and the patients’ medical status demands that
one consider the following points when selecting this Financial support and sponsorship
surgical method:
None.
(1) This surgical approach is appropriate for women Conflicts of interest
and patients engaged in light physical labor because
of the effect of muscle harvest on abdominal wall There are no conflicts of interest.
strength. For men and patients engaged in moderate
to heavy physical labor, the method should be selected Patient consent
only after careful consideration. During surgery, the Informed consent was obtained from the patients.

90 Plastic and Aesthetic Research ¦ Volume 4 ¦ May 26, 2017