Management of Giant Keloids Using Full-Thickness Skin Grafts: A Case Series From a Low-Resource Region

Management of giant keloids in the submandibular and cervical regions remains challenging due to high recurrence rates, functional impairment, and limited access to adjuvant therapies in low-resource settings. Chronic inflammation, mechanical tension, and adnexal involvement may contribute to aggressive keloid behavior. Optimal reconstructive strategies in such cases remain controversial, particularly when postoperative radiotherapy is unavailable.

The authors present a case series of three male patients with giant submandibular and anterior cervical keloids associated with chronic suppurative changes and sinus tract formation. All patients underwent complete full-thickness excision of the keloid tissue, followed by immediate reconstruction using full-thickness skin grafts (FTSG). Postoperative management included structured intralesional and topical corticosteroid therapy. Clinical, functional, and photographic outcomes were evaluated during follow-up.

All full-thickness skin grafts demonstrated complete take without partial or total loss. Functional outcomes, including cervical mobility, mandibular movement, speech, and swallowing, improved markedly in all patients. No early keloid recurrence, wound complications, or graft-related morbidity was observed during the six-month follow-up period. Histopathologic examination revealed classic keloid architecture accompanied by chronic follicular inflammation and hidradenitis suppurativa-like features.

Complete full-thickness excision followed by tension-reducing reconstruction with FTSG represents a safe, effective, and reproducible option for selected giant submandibular and cervical keloids, particularly in low-resource settings. Removal of chronically inflamed adnexal structures combined with postoperative corticosteroid therapy may help reduce recurrence risk. This approach expands reconstructive strategies for complex craniofacial keloids when advanced adjuvant therapies are unavailable.