Wound Infection After Keloid Excision and Adjuvant Radiotherapy: Two Case Reports and Literature Review

The combination of surgical excision and adjuvant radiotherapy is widely accepted as one of the most effective treatments for keloids. Although wound infection following radiotherapy has been reported in several studies, no study has investigated how such infections are managed or whether they ultimately lead to keloid recurrence. Two patients, one male with an anterior chest keloid and one female with a mons pubis keloid, underwent surgical excision followed by adjuvant radiotherapy (20 Gy in four fractions) at our institution. Both patients developed wound infections following combined therapy, both of which were successfully treated using a comprehensive protocol. This protocol involved wound drainage and debridement, antibiotic administration, and moist wound healing. Complete healing was achieved in both cases, with no recurrence observed during the 18-month follow-up period. The possible causes of radiation-induced infection were analyzed, including radiation itself, atopic dermatitis and specific surgical areas (such as the mons pubis region). Our study successfully addressed wound infection by adopting an effective treatment protocol involving wound drainage and debridement, antibiotic administration, and moist wound healing. Although favorable results were obtained in the two keloid cases, optimizing radiotherapy in terms of radiation mode, dosage, fraction and timing is still necessary to reduce the incidence of radiation-induced wound infections. Neither of the two patients experienced keloid recurrence when treated with an effective therapy for wound infection. This result demonstrates that a favorable outcome can be achieved with the appropriate and timely treatment protocol, even if an infection occurs after radiotherapy. Further clinical studies and basic research are needed to investigate the underlying mechanisms of the favorable outcome following radiation-induced infections.