12-year-old girl with a history of prominent ears treated by otoplasty at the age of 8 years. A keloid progressively developed in both ears from one year after the operation. The keloids invaded the upper edge and posterior face of the upper poles. The right ear had a horizontal size of 3.2 cm and a vertical size of 2 cm, and the left ear was 2.7 cm x 1.5 cm respectively. The patient reported no pain or itching. Excision was indicated due to the large size of the lesions, with aesthetic and psychological repercussions. The operation was performed under general anaesthesia. Surgical treatment consisted of the following technique: an incision was made on the posterosuperior aspect of the keloid, from which a thin flap of the keloid skin cover was dissected, maintaining a pedicle of attachment to the normal skin on the anterior aspect of the ear. After lifting the flap to a suitable size, the remaining keloid was excised. The flap was sutured to the defect without tension. The size of the flaps was 2.5 cm x 1.5 cm on the right ear and 2 cm x 1 cm on the left ear. Pathological examination showed that the keloid nodules were covered by epidermis, and atrophy of the skin appendages was observed. Surgery was associated with other treatments, commonly used to prevent recurrence: intraoperative injection of corticosteroid (triamcinolone acetonide) into the surgical site, application of silicone gel to the resulting scars and pressotherapy with an elastic band. Silicone gel and pressotherapy were used for one year after surgery. The patient was monitored periodically.

The right ear flap had a small suture dehiscence, which healed by secondary intention within a few weeks with topical treatment. No necrosis or other complications developed. A satisfactory repair of the defects was achieved, with restoration of the normal contour of the ears. On the right ear a recurrence developed 5 years after the operation, forming a keloid in the operated area measuring 1.5 cm x 1 cm, which was treated with the same surgical procedure. There has been no recurrence in the left ear. At 18 years of age, both ears look good and the patient has regular check-ups.