KEY POINTS
- This retrospective series included 43 consecutive patients with 68 keloid lesions treated between 2020 and 2024. Lesions were retrospectively categorized as “complex” when associated with extensive skin involvement, prior irradiation, or connective-tissue disease.
- Postoperative RT started within 24 hours of excision. All lesions were treated with electrons using 6, 8, or 15 MeV and 0.5–1.0 cm bolus; the most common regimen was 18 Gy in 3 fractions, used for 45 lesions.
- Wound dehiscence was uncommon after treatment of simple keloids: only 2/39 lesions (5.1%) dehisced. By contrast, 14/18 extensively involved sites (77.8%) developed dehiscence; the lesion-level comparison was reported as p<0.001.
- The extensive-lesion result should be interpreted cautiously because those 18 sites came from only five patients, creating substantial within-patient clustering that limits conventional statistical inference.
- Re-irradiation also appeared potentially important. Among 10 previously irradiated lesions, 2 dehisced; none of seven previously irradiated ear lesions did so, whereas two of three previously irradiated truncal lesions developed dehiscence.
- One patient with Marfan syndrome developed extensive wound separation after irradiation of inframammary and bilateral breast-reduction incisions, suggesting connective-tissue disorders may represent another high-risk setting.
- Despite sometimes severe wound separation, management was generally conservative. No patient required surgical debridement; nine of ten patients with dehiscence ultimately healed all affected sites, although one re-irradiated wound remained incompletely healed more than 300 days later.
CLINICAL TAKEAWAY
Postoperative RT for ordinary keloids still appears to carry a low wound-complication risk, but that reassurance may not extend to extensive disease, re-irradiation, or connective-tissue disorders. The striking 78% dehiscence rate in extensively involved sites is a useful counseling signal, although the very small and clustered dataset cannot define precise individual risk.