Background  Due to the high local tension, chest wall keloid tends to have a relatively large area and severe symptoms and is thus difficult to treat in clinical practice. Common surgical methods include direct resection and suture, skin flap transfer, and free skin grafting; however, due to the high local tension after surgery, there is still a lack of satisfactory treatment outcome and a low degree of satisfaction even in combination with postoperative radiotherapy.

  Objective  To investigate the clinical effect of keloid core excision combined with radiotherapy in the treatment of chest wall keloid and the degree of satisfaction of patients.

  Methods  A retrospective analysis was performed for the patients with chest wall keloid who underwent keloid core excision in our department from August 2016 to March 2021, and keloid core tissue was completely stripped and excised while the skin with a thickness of 1 mm was preserved. The patients underwent radiotherapy for 3-5 times after surgery, and the first session of radiotherapy was completed within 24 hours after surgery, with a single dose of 3-5 Gy and a total dose of 15-20 Gy. The patients were also given conventional treatment with silicone gel for external application and elastic clothing compression, and the patients with local hyperplasia were treated with glucocorticoid injection. The Patient and Observer Scar Assessment Scale (POSAS) was used to evaluate the changes of keloid after treatment, and a statistical analysis was performed for response rate and degree of satisfaction.

  Results  A total of 23 patients with 30 keloids were included in analysis, among whom there were 10 male patients and 13 female patients, with a median age of 29 years and a median course of disease of 96 months. The minimum area of lesion was 2 cm×2 cm, and the maximum area was 20 cm×7 cm. As for the location of lesion, of all 30 lesions, 21 lesions (70%) were located on the anterior chest wall, with 10 lesions (33%) on the manubrium sterni, 6 (20%) on the sternal body, 3 (10%) on the xiphoid process and costal arch and 2 (7%) in the anterior intercostal space, and the other 9 lesions (30%) were located on the posterior chest wall, with 8 (27%) on the scapula and 1 (3%) in the posterior intercostal space. Among these 30 keloids, 8 had focus of infection. The median follow-up time was 12 months. After treatment, there were significant reductions in the scores of Patient Scar Assessment Scale and Observer Scar Assessment Scale and the total of POSAS (all P <0.05). Among the 30 keloids, 14 had good response, 13 had certain response, and 3 had no response, resulting in an overall response rate of 90% (27/30). Of all 23 patients, 3 (13%) were very satisfied with the treatment outcome, 17 (74%) were satisfied, and 3 (13%) were not satisfied, with an overall satisfaction rate of 87% (20/23).

  Conclusion  Keloid core excision combined with postoperative electron beam radiation therapy is a safe and effective method for the treatment of chest wall keloid, especially for medium-sized and large keloids in the middle and upper sections of the sternum and multiple chest wall keloids.