Predictive Factors for Recurrence of Giant Cervical-Mental Keloid Scars in Adults

The general objective of this study is to identify the predictive factors of recurrence after surgery for cervico-mental keloid of at least ≥ 10 cm and reaching the sternum. This is a prospective cohort study of 32 adult Congolese Negroid males who had previously undergone keloidectomy with immediate closure or keloidectomy followed by dressings and then skin grafting. The study covers the period from January 1, 2011, to April 30, 2023, with a follow-up of at least 18 months. The majority of patients (71.7%) were aged between 20 and 49 years. The etiology was traumatic (beard shaving, post-traumatic wounds) in 74.9%. The majority of lesions (68.9%) were between 11 and 20 years. In half of the cases (53%), patients consulted in the presence of the 2nd and 3rd recurrence. Half of the patients received less than 5 sessions of corticosteroid infiltrations, i.e., 59.3%. Half of the cases (56.2%) recurred 2 years after surgery and had a keloid size between 20 - 29 cm long. The most commonly performed type of surgery (71.8%) was intrascar keloidectomy directed healing and skin graft. Recurrence was observed more in keloidectomy and immediate closure (66.6%) than in keloidectomy ＋ dressings and skin graft (34.3%). Keloidectomy and immediate closure were the sources of abscesses and suppurations in 88.8% of cases. The overall incidence of keloid recurrence is 13.0 (11.4 - 15.6) per 100 P-M. This incidence increases as the months go by. Predictive factors for keloid recurrence are post-surgery infection (31.3 per 100 P-M versus 1.8 per 100 P-M), size ≥ 30 cm (RR = 35.3 per 100 P-M) and a size of 20 - 29 cm (RR = 14.1 per 100 P-M), evolutionary duration of ≥ 10 years (RR = 23.0 per 100 P-M) and finally immediate simple suture (RR = 1 per 100 P-M). Protective predictive factors were keloidectomy ＋ dressing ＋ graft ＋ corticosteroid therapy. Finally, the Kaplan Meir curve of patients according to secondary procedure performed after keloidectomy shows that the incidence of recurrence is significantly (Log-rank, p = 0.029) higher in patients whose secondary procedure performed is immediate closure (lC = 19.4 for P-M) compared to those whose secondary procedure is dressings and skin grafts (lC = 9.6 for P-M). It, therefore, emerges from this study that for large keloid scars of the chin and neck at least 10 cm long, intracranial surgery followed by dressings and skin grafts associated with corticosteroid infiltrations gives a low rate of recurrence.