Background: Auricular keloids present a significant therapeutic challenge due to their propensity for high recurrence rates and the potential for both aesthetic and functional deformities. Although numerous adjuvant treatments have been proposed, recurrence remains prevalent when factors such as tension, contour preservation, and vascularity are not adequately addressed.
Case presentation: This study presents a surgical technique that emphasizes the complete excision of keloids while preserving the overlying skin as a fillet flap for reconstruction. Following methylene blue marking and local anesthetic infiltration, the keloid core is excised, ensuring the maintenance of cartilaginous integrity to preserve the auricular contour. The preserved skin flap is then repositioned for layered wound closure, achieving a tension-free repair. A bolster dressing is applied to prevent hematoma formation and eliminate dead space. Adjuvant therapies, including intralesional corticosteroids, 5-fluorouracil, and laser therapy, were considered as complementary modalities to further reduce the risk of recurrence.
Conclusion: The fillet flap technique offers a reliable reconstructive option following auricular keloid excision, ensuring adequate vascularity and contour preservation. This approach provides improved cosmetic outcomes and a lower recurrence rate compared to excision alone. Careful postoperative management and individualized adjuvant therapy remain essential for optimizing long-term results.
auricular keloids, keloid therapy, surgery of auricular keloids, fillet flap, keloid recurrence, keloid excision
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