Nucleoresection Combined with Punch Extraction: A Keloid Surgical Technique Worth Promoting

Background

Treating large keloids is difficult. Surgery can reduce the size of a keloid and make
postoperative radiotherapy more effective. However, choosing the right surgical method is
important. Traditional surgery that removes the keloid and closes the wound with stitches
or skin flaps often increases tension on the skin. This tension is a major reason why keloids
form again. In addition, these traditional methods are not suitable for very large keloids.

Methods

Keloid nucleoresection solves this problem by removing only the core of the keloid while
keeping the surface skin intact. This reduces the keloid volume without changing the skin
surface area, which helps prevent tension after surgery.
The punch extraction technique further improves the results by making the skin flap more
even, allowing trapped blood to drain, and improving the overall effectiveness of the
procedure.

Results

Between November 2021 and October 2024, 369 patients with keloids were treated using
keloid nucleoresection combined with punch extraction, followed by routine superficial
radiotherapy. Patients were followed for 6 to 40 months. No patient developed severe or
widespread recurrence. Small, localized recurrences were successfully controlled with drug
injections. Scar severity and pain scores (VSS and VAS) were significantly reduced.

Conclusion

Combining keloid nucleoresection with punch extraction is an effective surgical treatment
for large keloids and should be widely adopted. Postoperative superficial radiotherapy
further helps reduce the risk of recurrence.