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Keloids are scars that extend beyond the borders of the original wound. They are difficult to cure because of their high recurrence rate, particularly in large keloids that require skin grafts. This article describes a study to compare the effectiveness of a new technique, a combination precut, preradiotherapy method, with the conventional surgical method of keloid skin graft treatment.Fifty-three patients with chest wall keloids were treated from April 2005 to June 2011. Twenty-nine patients were treated with conventional surgery and radiotherapy. Keloids were removed from these patients, and their wounds were closed with skin grafts. If the grafts survived well, radiotherapy was applied, and the sutures were removed. Twenty-four patients were treated using the novel precut, preradiotherapy method. An incision was made down to the subcutaneous layer around the edge of the keloid, and radiotherapy was applied on the following day. Then the keloid was removed, and the wound was closed using a skin graft. Radiotherapy was applied for the second time when the graft was found to have survived. Patients underwent follow-up examinations 6 and 12 months after surgery. The scar at the operation site and aesthetic satisfaction were recorded and compared.The recurrence rate was 55.2% in the conventional group and 16.7% in the precut group, a significant difference (χ2 = 6.73, p < .01). There was a significant difference in aesthetic satisfaction between the two groups, with 48.3% in the conventional group rating their satisfaction as poor versus 8.3% in the precut group (χ2 = 7.50, p < .01).The precut, preradiotherapy strategy may be a promising treatment option for patients with large keloids that require excision and skin graft repair.