Evaluation of Individualized Sequential Therapy Centered on Surgical Excision and Superficial Radiotherapy in Treating Keloids in the Anterior Chest Wall

ABSTRACT Background This study aims to evaluate the efficacy of individualized sequential therapy centered on surgical excision and superficial radiotherapy for the treatment of sternal keloids. Methods This study retrospectively analyzed the clinical data of 42 patients with sternal keloids admitted to a tertiary hospital in eastern China between January 2022 and December 2024. All patients received an individualized sequential therapy. Preoperatively, surgical approaches were selected based on the size and morphology of the keloids, including direct excision with tension‐reduction sutures, flap reconstruction following excision, punch excision, and a combination of surgical excision and punch excision. Postoperative sequential adjuvant therapies included superficial radiotherapy, topical anti‐scarring medications and dressings, and regular fractional laser treatment combined with compound betamethasone importation, sustained for 6 months. The Vancouver Scar Scale (VSS) and the Patient and Observer Scar Assessment Scale (POSAS) were used to evaluate scar improvement and clinical efficacy before treatment and at 12 months postoperatively. The response rate, recurrence rate, adverse reactions, and long‐term outcomes were statistically analyzed. Results At 1 year postoperatively, VSS, OSAS, and PSAS scores decreased across all four subgroups compared with baseline. Significant differences between pre‐ and post‐treatment scores were observed in the tension‐reducing suture repair group ( n = 18), IMAP flap reconstruction group ( n = 9), and punch excision therapy group ( n = 10) (all p < 0.05). The combined excision group ( n = 5) showed a downward trend in postoperative scores, but the difference did not reach statistical significance ( p = 0.063). The overall response rate was 88.1%. Postoperative radiation dermatitis occurred in 3 cases, which healed well after symptomatic management. During the follow‐up period, recurrence was observed in 5 patients (11.9%), whose symptoms were alleviated following local injections of compound betamethasone. At the end of the follow‐up period ranging from 12 to 24 months (mean: 19 months), all patients maintained stable or improved scar conditions, indicating favorable long‐term efficacy. Conclusion Individualized sequential therapy centered on surgical excision and superficial radiotherapy, combined with other long‐term adjuvant treatments, demonstrates superior efficacy in the treatment of sternal keloids and is recommended for clinical application.