An Unusually Huge Keloid Complicating a Unilateral Otoplasty.

Abstract

Giant recurrent auricular keloids, particularly those complicated by donor-site involvement, present significant therapeutic challenges due to aggressive fibroblast biology and high recurrence rates. We report a complex case of a 15-year-old female who developed a massive recurrent auricular keloid with associated abdominal donor-site keloid following otoplasty and subsequent skin grafting. Initial otoplasty at age 10 was complicated by keloid formation, requiring excision and abdominal full-thickness grafting. By age 15, she presented with a recurrent auricular keloid causing auricular deformity, tragus distortion, and external auditory canal obstruction, alongside a donor-site keloid. Management involved the radical excision of both keloids. To minimize tension-induced recurrence, the auricular wound underwent deliberate secondary intention healing, while the abdominal site was closed primarily under minimal tension. Adjuvant therapy comprised 6 weekly intralesional interferon-gamma (IFN-γ) injections (1 million units auricle; 0.5 million units abdomen). This multimodal approach leveraged IFN-γ's antifibrotic properties, including ferroptosis induction in keloid fibroblasts. At 1-year follow-up, both sites exhibited sustained remission with good fibrosis and acceptable cosmesis without recurrence. This case demonstrates that tension-free excision with secondary intention healing, combined with intralesional IFN-γ, offers a promising strategy for managing complex pediatric keloids where conventional therapies carry substantial limitations. The protocol effectively addresses both biological recurrence drivers and psychosocial burdens inherent to disfiguring scars.