A systematic review published in
September 2026 by Dr. Badariyatud Dini at Maulana Malik Ibrahim State Islamic
University investigated the patient, lesion, and surgical factors that predict
keloid scar recurrence after surgical excision. The study synthesized global
primary evidence published between January 2020 and September 2026. The
findings demonstrate that post-operative keloid regrowth is driven by an
interactive combination of inherited genetic susceptibility, lesion size,
biological activity, mechanical tension, and wound healing complications such
as infection. This comprehensive prognostic framework helps healthcare
providers identify high-risk individuals and tailor perioperative care to
prevent keloid regrowth.
The Growing Burden of
Persistent Keloid Scarring
Keloids are pathological
fibroproliferative scars that grow beyond the boundaries of an original skin
injury. They cause physical discomfort—including chronic pain and itching—as
well as severe cosmetic deformity and psychosocial distress. While surgical
excision is often required for large, symptomatic, or treatment-resistant
scars, surgical removal alone frequently fails because it does not stop the
body's abnormal scar-forming response. Understanding why keloids recur in
certain patients despite surgical treatment and follow-up therapy remains a
central challenge in plastic surgery and dermatology.
Systematic Method for
Analyzing Risk Predictors
Dr. Badariyatud Dini conducted a
systematic review following the PRISMA 2020 guidelines and frameworks for
prognostic factor research. Literature searches were executed across databases
including Scopus, PubMed/MEDLINE, Embase, Web of Science, and CENTRAL for human
studies published from January 2020 to September 2026.
From 1,142 identified records, 24
primary observational cohort and clinical studies evaluating patient, lesion,
and surgical predictors were included in the qualitative synthesis. Risk of
bias was appraised using the Quality In Prognosis Studies (QUIPS) tool, and
certainty of evidence was evaluated using adapted GRADE criteria. Prognostic
factors were grouped across three primary domains:
- Patient-related characteristics: Age, sex,
family history, and systemic biomarkers.
- Lesion-related characteristics: Anatomical
location, size, biological activity, and mechanical tension.
- Surgery-related conditions: Excision
techniques, surgical margins, wound dehiscence, local tension, and
post-operative infection.
Post-operative adjuvant
therapies—such as radiation, steroid injections, and compression—were evaluated
separately as treatment modifiers rather than baseline risk factors.
Key Findings on Keloid
Recurrence Predictors
The synthesis revealed that
keloid recurrence risk is determined by specific biological and surgical
predictors rather than treatment protocols alone:
- Family History and Genetics: Inherited
susceptibility plays a major role, with familial keloid history
consistently increasing recurrence risk across diverse populations.
- Lesion Size and Biological Activity: Larger
scars (such as those measuring $\ge 2\text{ cm}$ or having large
diameters) and lesions with high biological activity scores show higher
rates of recurrence.
- Anatomical Site and Mechanical Tension: High-tension
body regions—such as the chest, shoulders, and earlobes—demonstrate
variable and frequently elevated recurrence rates compared to low-tension
regions.
- Post-Operative Infection and Complications:
Wound-related complications and infections after surgery were strongly
associated with keloid regrowth. In multivariable models, post-operative
complications increased the odds of recurrence significantly.
- Biomarkers: Isolated systemic markers, such
as pre-operative serum vitamin D levels, showed no independent predictive
value for recurrence.
Real-World Impact and Clinical
Implications
These findings shift the paradigm
of scar management from procedure-focused care to personalized, risk-adapted
management. Clinicians can use these predictors prior to surgery to identify
high-risk patients based on family history, scar size, and anatomical tension.
Furthermore, preventing post-operative wound infection and minimizing wound
tension emerge as modifiable clinical targets that directly reduce the
likelihood of recurrence.
"Keloid recurrence after
excision is determined by the interaction of patient susceptibility, lesion
characteristics, anatomical and mechanical factors, surgical conditions, and
postoperative wound events," stated Dr. Badariyatud Dini of Maulana Malik
Ibrahim State Islamic University. "These findings challenge the
conventional view that recurrence mainly reflects inadequate excision or
insufficient adjuvant therapy."
Author Profile
Dr. Badariyatud Dini holds
a medical degree (dr.) and serves as a researcher and academic faculty member
at Maulana Malik Ibrahim State Islamic University, Indonesia. Her field of
expertise encompasses wound healing, surgical prognosis, scar management, and
clinical research methodologies in dermatology and surgery.
Source
- Article Title: Patient, Lesion, and Surgical
Predictors of Keloid Recurrence After Excision: A Systematic Review
- Journal Name: Multitech Journal of
Science and Technology (MJST)
- Publication Year: 2026
- DOI: https://doi.org/10.59890/mjst.v4i9.338
- Official URL: https://slamultitechpublisher.my.id/index.php/mjst/index
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