Surgical excision combined with postoperative radiotherapy is considered one of the most radical but most effective keloid therapeutic option. However, radiotherapy may not be appropriate for all keloid patients. In this study, we propose an alternate approach to prevent keloid recurrence and provide preliminary assessment in clinical efficacy of this treatment for keloids. Forty consecutive patients with different keloid sites underwent excision without postoperative radiation. After surgery, the tension offloading device was used at least 6 months for the purpose of continuous tension reduction at surgery incision. Scars were assessed independently using scar scale at before and 24‐month follow‐up. Overall, 38 patients completed this research. Clinical results showed that 35 patients achieved healing with an aesthetic appearance at 24‐month follow‐up. Three patients showed relapse and the recurrence rate was 7.9%. Both of VSS (Vancouver Scar Scale) and JSW (Japan Scar Workshop Scar Scale) scores decreased significantly at 24‐month follow‐up visit than before. No severe complications were reported. Using the tension offloading device could greatly decrease tension on the surgical incision. The technique of continuous tension reduction could be used as an alternative method to prevent keloid recurrence under the condition of without radiotherapy.

Objective: This clinical study describes a reconstructive method for facial soft-tissue defects that uses the pre-expanded forehead flap and minimizes donor site morbidities. Methods: The surgery was subdivided into 3 stages. First stage, an appropriately sized expander was buried underneath the forehead. Second stage, after adequate inflation of the expander, a forehead flap based on the frontal branches of the superficial temporal artery was raised, and the distal portion of the flap was used to reconstruct the facial defect. The cutaneous pedicle of the flap was designed near the frontal hairline. Third stage, 3 weeks later, the flap pedicle was divided, and the forehead incisional scar was melted into the neoreconstructed hairline. Results: Between July 2010 and December 2016, 16 patients underwent facial defect reconstruction. Etiologies included postburn scar (31%), melanocytic nevus (56%), and hemangioma (13%). The mean size of the defects was 8.78 × 5.06 cm (range, 3 × 2.5 to 15 × 7 cm). The average dimension of the forehead flap was 21.63 × 7.38 cm (range, 12 × 4 to 28 × 10 cm). Fifteen flaps survived without any perfusion-related complications. Venous congestion occurred in 1 flap and gradually subsided without any flap loss. Patients were followed after surgery, ranging from 4 to 48 months. Patients and/or their family members were satisfied with the final aesthetic outcomes. Conclusion: Facial defect reconstruction using a pre-expanded forehead flap, with the donor-site incisional scar designed along the hairline, can not only provide sufficient tissue for defect reconstruction, but also maximally reduce donor-site morbidities.