Cultured epithelial autografts in the treatment of extensive recalcitrant keloids.

A 42-year-old black man presented with an extensive keloid on the anterior section of his chest wall. He had acne as a child and developed a number of significant keloids, the most symptomatic being the keloid on his chest wall. This keloid had been treated with excision approximately 10 years previously in another city, followed by placement of a number of mesh split-thickness skin grafts (STSGs) obtained from his thighs. According to the patient, the superior edge of the keloid had also been irradiated some time after surgery. The entire keloid located on his chest wall had regrown significantly, causing the patient problems with bending at the waist and with full range of motion in his shoulders. The recurrence had been treated with intralesional corticosteroids and cryotherapy (separately and combined), as well as silicone gel and flurandrenolide (Cordran tape, Lilly, Eli and Co, Indianapolis, Ind) without significant improvement. In addition, a smaller keloid had been excised on his back and the epidermis removed from the keloid and replaced over the wound, with significant regrowth of that keloid as well. On physical examination the patient had an extensive keloid encompassing the surface area extending from the clavicle to the inframammary crease (Figure 1). The inferior portion of the keloid, which was the thickest portion, had curled under itself and had completely encased the patient’s areolae, which were not visible. In addition, the patient had a number of keloids located on his back and upper extremities. He had hypertrophic, but not keloidal, scars on his thighs at the donor sites from his previous STSGs.