Abstract
Various treatments are available for auricular keloids, but none has an absolute advantage. A practical and safe therapy to optimize the surgical outcome for auricular keloids is needed. We adopted a multimodal treatment of surgical enucleation, core fillet flap reconstruction, intraoperative corticosteroid injection, and immediate postoperative radiotherapy. There were no routine intralesional corticosteroid injections during follow-up. Keloid recurrences, complications, and risk factors for recurrences were analyzed. The outcome was compared with other published literatures. 45 auricular keloids were included in this study. 85.7% were female with an average age of 27.1 ± 7.5 years, and averaged size was 1.8 × 1.2 ± 0.9 × 0.6 cm. 71.1% were located at ear helix with 28.9% at the ear lobe. Nine keloids were classified as Chang-Park classification type I, 30 for type II, two for type III, and four for IV. The average radiation dosage was 1578.6 cGy. The recurrence rate was 6.7% at an average 24.1-month follow-up. There were no complications of surgery, radiotherapy, and intralesional corticosteroid injection. Our recurrence rate was lower than those in mono-adjuvant therapies of intraoperative corticosteroid injection or radiotherapy. This one-session multimodal approach optimizes treating auricular keloids with a low recurrence rate and minimal post-radiation and long-term corticosteroid injection-related complications.
Highlights
There were no significant differences in age, sex, previous treatment history, size, location at the ear, and type of Chang-Park classification among the auricular keloids with recurrences and without recurrences (Table 3)
This novel multimodal approach in a single session composed of keloid enucleation, reconstruction with a core fillet flap, intraoperative intralesional corticosteroid injection, and immediate postoperative radiotherapy is an optimal regimen to treat auricular keloids with a low recurrence rate and few complications associated with radiotherapy and long-term corticosteroid injection
Auricular keloids are challenging for surgical resection due to the preservation of the three-dimensional contour of the external ear and the scarcity of tissue laxity[1]
Summary
Patients who received a multimodal therapy composed of surgical enucleation, core fillet flap reconstruction, intraoperative intralesional injection, and immediate postoperative radiotherapy were included for analyses. The clinical characteristics, including age, sex, previous history of keloid treatment, size and location of the auricular keloid, postoperative wound healing, recurrence, and follow-up periods, were recorded. The surgical method of enucleation and reconstruction with a core fillet flap was performed under local anesthesia (1% lidocaine with 1:100,000 epinephrine). The fillet flap is an axial pedicle flap, first introduced in reconstructing traumatic a mputation[5], utilizing the "spare parts" from the adjacent tissue We used this method to reconstruct the wound after keloidectomy[6]. We further analyzed the clinical characteristics of patients, type of auricular keloids, and radiation dosage to determine the risk factors for keloid recurrences. Informed consent was waived by Chang Gung Medical Foundation IRB
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