PMC4782658_01
Preoperative view of reluctant chest keloid
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On physical examination, a large 6(W) (x) 8(L) (x) 1.5cm (thick) epidermal mass was seen over the midline of his chest below the cartilago ensiformis (Figure 1).
IMAP Flap design during the excision
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The patient underwent complete resection of the keloid (Figure 2).
IMAP Flap was rotated 180  with primary closure of the donor site
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The donor site was closed directly, which releasing tension by subcutaneous and fascial sutures (Figure 3).Histological analysis revealed a typical keloid feature.
Follow up after postoperative radiotherapy
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At his last follow-up (18 months later), he was asymptomatic and demonstrated no sign of keloids at the donor or recipient site (Figure 4).