Keloid Excision Research Articles

The Relationship Between Preoperative Vitamin D Levels and Keloid Recurrence.

Keloids, characterized by excessive collagen deposition, often recur despite various treatments. This study explores the association between preoperative serum vitamin D levels and keloid recurrence in a Korean population. A retrospective cohort of 160 patients who underwent keloid excision was analyzed. Preoperative serum 25(OH) vitamin D and 1,25(OH)2 vitamin D levels were measured. Recurrence rates were compared using hierarchical logistic regression, adjusting for potential confounders. Age was significantly associated with keloid recurrence (OR: 0.934, p = 0.009), indicating older age was linked to lower recurrence risk. No significant association was found between preoperative 25(OH) vitamin D (p = 0.395) and 1,25(OH)2 vitamin D levels (p = 0.925) and keloid recurrence. Preoperative vitamin D levels do not predict keloid recurrence in this Korean cohort, while age is a significant predictor. Understanding the multifactorial nature of keloid pathogenesis requires further investigation into other potential risk factors.

Effect of a Chest Compression Device for Scar Prevention Combined with Nurse-Patient WeChat Group on Scar Formation after Keloid Excision

Objective: To investigate the effect of a chest compression device for scar prevention combined with a nurse-patient WeChat group on scar formation after keloid excision. Methods: Forty patients with chest wall keloids who underwent keloid excision surgery at the Department of Plastic and Reconstructive Surgery, First Medical Center of PLA General Hospital from June 2022 to June 2024 were selected. They were randomly divided into two groups: the observation group (20 cases) and the control group (20 cases). Both groups underwent routine keloid excision, followed by compression therapy for 6 months. The observation group used a chest compression device, while the control group used a compression garment. Scar width, hypertrophy, and Vancouver Scar Scale (VSS) scores were compared between the two groups. Results: There were no significant differences between the two groups in terms of gender, age, disease course, lesion area, and lesion site (P > 0.05). The overall effective rate in the observation group was 95.00%, significantly higher than the 65.00% in the control group, with a statistically significant difference (P < 0.05). After a 6-month follow-up, all VSS indicators (except for pliability) in the observation group (using the chest compression device) were significantly lower than those in the control group (P < 0.05). Conclusion: Compared to the traditional compression garment, the chest compression device for scar prevention is more effective in preventing scar hypertrophy after chest wall keloid excision and improving the appearance of scars. It is worth promoting for clinical application.

An analysis of treatment outcomes and recurrence rates of surgical excision versus intralesional steroid injections for pediatric keloids.

An analysis of treatment outcomes and recurrence rates of surgical excision versus intralesional steroid injections for pediatric keloids.

Immediately Injections of Botulinum Toxin A After Surgical Excision for Ear Keloids: A Retrospective Study.

Ear keloids are pathologic scar hyperplasia in the ear region. The most therapeutic approach was surgical shave excision with radiation therapy. However, radiation therapy is easily delivered to healthy surrounding tissues. In the last years, injections with botulinum toxin type A (BTX-A) have been proven to improve surgical scars effectively in clinical trials. This study aimed to evaluate the effect of immediate injections of BTX-A after surgical excision for ear keloids. From January 2020 to January 2023, 33 consecutive patients with ear keloids were enrolled. All patients underwent scar excision and revision at the same time when they needed BTX-A. It was injected into surgical wound closure immediately after surgery. The results of this study were evaluated at follow-up from 7 to 18 months using the Vancouver Scar Scale (VSS) and the Visual Analogue Scale (VAS). From January 2020 to January 2023, 33 patients received concomitant therapy of immediate injections of BTX-A after surgery for ear keloids. The patients were evaluated at follow-ups lasting 7 to 18 months. Only one case recurred within the follow-up period, and no adverse effects were reported. This study demonstrates that significant cosmetic outcomes in ear keloid treatment were achieved after early postsurgical BTX-A injections. The patients reported high satisfaction and few complications.

Assessment of the efficacy and safety of auricular keloids excision followed by 5-aminolevulinic acid photodynamic therapy

BackgroundAuricular keloids are a significant clinical challenge, which adversely affect the life of the patient at the level of aesthetic and psychological well-being. Despite various treatment modalities, a universally effective therapy has yet to be established. Photodynamic therapy (PDT) offers a promising approach by inhibiting the abnormal proliferation of fibroblasts while minimizing damage to surrounding healthy cells and tissues. This study evaluates the clinical outcomes of auricular keloid patients treated with excision followed by 5-aminolevulinic acid photodynamic therapy (ALA-PDT). MethodsThis study included 8 patients diagnosed with auricular keloids based on pathological examination and clinical presentation. Following surgical excision of the auricular keloids, topical 5-ALA solution was applied for 4 h. Then each lesion was irradiated with 120 J/cm² using a red LED (635-nm laser) for 20 min. Patients received 3–5 courses of 5-aminolevulinic acid photodynamic therapy (ALA-PDT) during and after the surgery. ResultsAmong the 8 patients treated, auricular keloids were completely controlled with the combination therapy. During a follow-up period of 2.7 years (range: 1.8–4.1 years), all patients exhibited excellent outcomes with no recurrence of keloids. ConclusionsThe combination of surgical excision and 5-aminolevulinic acid photodynamic therapy (ALA-PDT) is an effective and safe treatment for auricular keloids. This combined approach shows promise as an alternative clinical treatment for managing auricular keloids.

Superiorly Based Preauricular Flap for Total Ear Lobe Reconstruction Following a Large Keloid Excision.

A large keloid on the right earlobe that extended to the infraauricular region was the reason for the 42-year-old woman's referral for treatment. The entire thickness of the earlobe was implicated in the surgical defect that resulted from the severe keloid excision. We employed a straightforward technique to provide a pleasing appearance while repairing the entire lobe in a single stage without the need for grafts. In addition to being ornamental, ear lobules provide a crucial point of reference for facial symmetry while wearing earrings. It is obviously unnatural from an aesthetic standpoint to lose them. Numerous techniques created to reconstruct this deformity have offered a range of benefits and drawbacks. A case of big ear lobe keloid with whole ear lobe reconstruction employing a new, single-stage, superiorly based Preauricular flap technique that is easy to master and produces good results in terms of absence of recurrence or no any deformity even after a lengthy follow-up period has been presented.

Development of huge keloid at donor site and recurrent keloid at graft site after excision of pubic keloid followed by split-thickness skin graft: A case report.

Keloids are the result of abnormal tissue scarring that occur after skin injuries leading to pain, psychological distress, and impaired quality of life. Despite the high recurrence rate after surgical treatment, excision is often inevitable for symptom control. A 32-year-old female presented with a huge keloid on the pubic area accompanied by severe pain, pruritus, and infectious discharge. She also had multiple keloids on her chest and shoulders, indicating a strong predisposition to keloid formation. While high potential for recurrence was anticipated, surgical excision was inevitable for symptom control. Complete keloid excision followed by split-thickness skin graft was performed. Pathological report revealed keloid accompanied by ruptured epidermal inclusion cyst. Although postoperative care was highly recommended for prevention of keloid recurrence, the patient refused any additional management due to her financial difficulties. At postoperative 8 months, mild degree of keloid or hypertrophic scar at marginal area of the graft was observed, suggesting the potential sign of keloid recurrence. The patient voluntarily discontinued the outpatient follow-up for 2 years, and then returned with huge keloid not only at the graft site but also at the donor site. Keloid with inflamed epidermal inclusion cyst can cause severe pain where surgical excision is unavoidable, regardless of the high potential for recurrence. Additional postoperative care is necessary to prevent recurrence. Furthermore, attempts to minimize new keloid formation at the donor site after split-thickness skin graft, such as thin skin harvest or selecting the scalp as the donor site, should be considered.

Keloid Excision with Debulking Technique on the Left Ear Helix

Keloid Excision with Debulking Technique on the Left Ear Helix

Can Electrical Stimulation Prevent Recurrence of Keloid Scars? A Scoping Review.

Objective: Keloids represent a symptomatic, aberrant healing process that is difficult to treat with high recurrence rates spanning from 55% to 100% if treated via excision without adjuvant therapy. Electrical stimulation (ES) has demonstrated findings that suggest it could reduce the recurrence rate of keloids after resection. Therefore, the aim of this study is to conduct a scoping review to investigate ES as an adjuvant therapy for decreasing keloid recurrence after excision. Approach: A scoping review was performed using PubMed and Web of Science databases. The search strategy encompassed terms linking keloids and various aspects of electrical stimulation. Results: Our search yielded 2,229 articles, of which 115 articles were analyzed as full text and 1 article met inclusion criteria. Despite this, ES has demonstrated other evidence that suggests its utility. ES has been shown to counter keloidic features by reducing mast cell counts, shifting wound composition from M2 to M1 macrophages, promoting angiogenesis, and controlling fibroblast orientation and location. An alternating current will orient fibroblasts perpendicular to the current without unintended migration. Innovation: Our study indicates that, based on a compilation of clinical and preclinical in vitro data, the optimal scenario for ES in the role of keloid treatment is after excision with a biphasic pulsed application and square waveform. Conclusions: ES could serve as a multifaceted, adjuvant treatment after keloid excision, steering the healing process away from keloid-associated characteristics. Its cost-effectiveness means it could be adopted globally, providing a strategy to mitigate the burden of keloids irrespective of other available treatments or economic conditions.

Intramarginal Excision of Keloid with Application of Kshara Taila

The destruction/ break/ rupture/ discontinuity of body/tissue/ part of body is called “Vrana”. The definition of Granthi is very well described by Acharya Vagbhata and Acharya Sushruta which seems to be more or less the same. According to Vagbhata, Malas (Doshas) of which Kapha being predominant, vitiating the Medas (fat), Mamsa (muscle) and Asra (blood) gets localised in these tissues and produce a round elevated growth, compact in nature which is called Granthi. Acharya Sushruta has explained that “the scars of a wound never disappear even after complete healing and its imprint persists lifelong and it is called Vrana. This phenomenon of Vrana is not only limited to cutaneous lesion but may also extend upto muscles blood vessels, ligaments, bones, joints, visceral organs and other vital parts of body. According to Sushruta, Granthi is a Vrita (round), Unnata (elevated), Vigrathita (hard) swelling by pathological involvement of Mansa, Rakta and Meda. Modern science compares Vranagranthi to keloid. It is a tumour arising from fibro proliferative disorders of the dermis. The main phenomenon is the excessive deposition of extracellular matrix proteins, which is composed by collagen fibres. It develops exclusively in humans. There is no proven, efficient treatment for keloid. This case study will lead to the development of new and improved keloid treatment methods.

Parecoxib decreases cellular growth and Bcl-2 protein levels in primary cultures of keloid fibroblasts.

Keloids seem to overexpress cyclo-oxygenase-2 (COX-2), suggesting a role in its deregulated pathway in inducing an altered epithelial-mesenchymal interaction, which may be responsible for the overgrowth of dermal components resulting in scars or keloid lesions. This study aimed to evaluate the effect of Parecoxib, a COX-2 inhibitor, on cell growth in fibroblast primary cultures obtained from human keloid tissues. Tissue explants were obtained from patients who underwent intralesional excision of untreated keloids; central fractions were isolated from keloid tissues and used for establishing distinct primary cultures. Appropriate aliquots of Parecoxib, a COX-2 inhibitor were diluted to obtain the concentration used in the experimental protocols in vitro (1, 10 or 100 μM). Treatment with Parecoxib (at all concentrations) caused a significant decrease in cellular growth from 24 hours onwards, and with a maximum at 72 hours (P < .02). Moreover, at 72 hours Parecoxib significantly reduced cellular vitality. Parecoxib treatment also induced an increase in fragmented nuclei with a maximum effect at 100 μM and a significant decrease in Bcl-2 and an increase in activated caspase-3 protein levels at 72 hours compared with control untreated cultures. Our findings suggest a potential use of the COX-2 inhibitor, Parecoxib, as the therapy for keloids.

Recurrent Auricular Keloid – Treated by Kshar Sutra (Medicated Seton) Therapy: A Case Report

Auricular keloids may develop either on the helix or anterior and posterior lobes up to several years after piercing, and they do not regress spontaneously. Many techniques have been developed to treat these disfiguring lesions with varying successes. Kshar sutra (medicated seton) is a medicated thread that can be readily ligated at the base of the ear keloid. Due to the high recurrence rate observed in auricular keloids following surgical excision, we opted to employ the Kshar sutra technique for excision with minimum cosmetic deformity of the pinna and evaluate the duration required to excise and the recurrence of ear keloid after a follow up of two years. A 28-year-old female with a recurrent keloid on the left ear auricle was excised with kshar sutra (medicated seton) ligation. The wound heals entirely in the post-operative period. The patient followup was conducted after a month, one year and two years. The duration required to excise the keloid was three days. No recurrence of keloid after Kshar sutra (medicated seton) ligation was noted during the followup period of two years. Kshar sutra (medicated seton) ligation for ear keloid excision is a viable, minimally invasive technique to avoid recurrence and minimize cosmetic deformities of the pinna.

Risk factors for recurrence after keloid surgery with electron radiotherapy.

The aim of this study was to investigate the effect of postoperative electron radiotherapy (RT) on local control for keloids and to identify risk factors for recurrence. The clinical data of 82 patients treated at our institution from January 2015 to October 2019 were collected. The data included the general condition of the patients, clinical characteristics of the keloids, treatment plan, local control, and treatment side effects. A total of 82 patients (129 keloids) were included. The study included 23 men (28%) and 59 females (72%). The median patient age was 32 years (range, 18-67 years). Twenty-six recurrences were observed, and the 1-, 3-, and 5-year local control rates were 93%, 81%, and 73%, respectively. Univariate analysis revealed that age (P = .03), hypertension (P = .04), scar shape (P < .001), primary site (P = .02), maximum lesion diameter (P < .001), pain and itching (P = .005), local tension (P = .005), and infection (P < .001) were risk factors for local recurrence. Multivariable analysis revealed that maximum lesion diameter (P < .001), infection (P < .001), interval between surgery and RT (P = .02), and previous treatment (P = .02) were independent risk factors. Complete excision of keloids combined with electron RT is safe and seemingly effective. For keloids with a high risk of recurrence, more aggressive treatment should be chosen, and further prospective studies are needed to explore the optimal treatment.

Ear keloid treatment using subepidermal excision-assisted electrophotobiomodulation

Background Keloids are challenging problems that have an aesthetic and psychological impact on patients who are genetically susceptible, especially in exposed areas. Moreover, treatment modalities are known to have a high incidence of recurrence. Aim We present our experience in subepidermal excision combined with E-light therapy (electrophotobiomodulation) in the treatment of ear keloids. Patients and methods Thirty-five patients who were presented with ear keloids were included. Under local anesthesia, a flap of keloid epidermis and a thin layer of the scar underneath were raised from the fibrous keloid core which, in turn, was extirpated leaving a thin margin of scar tissue (subepidermal excision). 2 weeks later after complete healing, all patients were subjected to a combination of radiofrequency (RF) and intense pulsed light (IPL) sessions (E-light). The outcome was assessed by the incidence of keloid recurrence at any time within the 2-year follow-up. Result The age of the patients ranged from 12 to 52 years with a median age of 34 years. There were 25 females (71%) and 10 males (29%). The average number of E-light therapy sessions was 6 (range 4–8 treatment sessions) at 4-week intervals. Keloid size had an average of 1 × 3 cm. In the 2-year follow-up, only two cases reported keloid recurrence. Of the patients, 33 did not report recurrence with a success rate of 95%. Conclusions Subepidermal keloid excision with a combination of radiofrequency and intense pulsed light is a promising multimodality treatment for ear keloids.

A Fully Digital Auricular Splint Workflow for Post-Keloid Excision.

Ear keloids are challenging lesions to treat due to high recurrence rates postexcision. Conservative compression techniques as adjunct treatment have been reported to be effective. An innovative technique of using computer-aided design/computed-aided manufacturing to print a customized auricular splint improves efficiency and comfort level for patients compared with conventional methods. The ear is scanned using an intraoral scanning 2 weeks postsurgery. A two-piece auricular splint is designed on the digital model, incorporating perforated projections for three nylon screws for retention of the splint. The splint is printed with clear acrylic material, postprocessed, and finished. The patient is taught to assemble the components of the splint and instructed to wear for at least 8 hours daily. The surgery site reviewed for any ulceration, pain, or recurrence of keloid for 6 months. During the 6-month review, the excision scar remained flat and pink. The patient also reports unrestricted daily activities. The digital workflow increases comfort for the patient and reduces the number of hours required to produce a customized auricular splint compared with conventional methods. A fully digital workflow for a printed auricular splint should be considered for adjunctive treatment to excision of ear keloids.

The Role of Radiation Therapy in Adult and Pediatric Keloid Management: A National Survey of Radiation Oncologists.

Radiation therapy is a promising modality for treating keloids after surgical excision. However, it is currently not standard practice among physicians because of concern surrounding the risk of radiation-induced secondary cancers, especially among pediatric patients. There is minimal research assessing the complications for radiation therapy in keloid management. The goal of this study was to determine radiation oncologists' perspectives about the utility and appropriateness of radiation therapy for keloid management in both adult and pediatric patients. This study also aimed to characterize radiation modality, dose, fractionation, and secondary complications observed by providers. An electronic survey was delivered to 3102 members of the American Society for Radiation Oncology. The survey subjects were radiation oncologists who are currently practicing in the United States. Rates of responses were analyzed. A total of 114 responses from practicing radiation oncologists were received. Of these, 113 providers (99.1%) supported radiation therapy for keloid management in adults, whereas only 54.9% supported radiation therapy for pediatric patients. Of 101 providers that treated adults in the past year, the majority used external beam: electrons (84.2%), applied 3 fraction regimens (54.4%), and delivered radiation within 24 hours postexcision (45.5%). In pediatric patients, only 42 providers reported treating at least 1 patient. The majority used electron beam radiation (76.2%), applied 3 faction regimens (65%), and delivered radiation on the same day of keloid excision (50.0%) The main concern when treating pediatric patients were risk of secondary malignancy (92.1%). Although radiation therapy appears to be a widely accepted adjuvant treatment option for adults with keloids, the use of radiation therapy for pediatric patients is less widely accepted because of concerns regarding secondary malignancy. The findings suggest additional studies need to be carried out to assess the risk of those complications.

Excision of Umbilical Keloids after Laparoscopic Surgery and Reconstruction by Skin Grafting: Original Research

Excision of Umbilical Keloids after Laparoscopic Surgery and Reconstruction by Skin Grafting: Original Research

A Working Classification and a Simple Effective Management Protocol for Ear Keloids.

The unpredictable behavior of scars in the ear makes it a nightmare in planning the management protocol for ear keloids. To understand and classify the ear keloid, a simple working classification based on the anatomical location has been proposed. Low recurrence rate should be the primary determinant in choosing a management protocol. The scar control protocol includes complete excision of the keloid, taking care not to extend to normal skin which was followed by a round-the-clock 24×7 management protocol for 6months to 1year. This study presents a prospective analysis of 71 patients with 106 ear keloids who underwent surgery in our clinic between 2007 and 2022. The management included complete excision, postoperative adjuvant therapy in the form of self-managed scar stabilization with bi-digital, bi-dimensional, bi-directional massage and corticosteroid therapy if warranted. Complete keloid excision with primary reconstruction was followed up to 1year, and recurrence rates were tracked during this period. Of the 71 patients, 91.54% were women. All lesions (n = 106) were treated by complete excision. The average age was between 15 and 30years. The overall recurrence rate was 5.6%. With our classification and protocol, we were able to achieve a consistent recurrence free state in 94.4% of patients. This journal requires that authors assign a level of evidence to each article. For a full description of these evidence-based medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Effect of platelet-rich plasma versus triamcinolone acetonide as adjuvant therapy to surgical excision of keloid

Effect of platelet-rich plasma versus triamcinolone acetonide as adjuvant therapy to surgical excision of keloid

Comprehensive treatment of ear keloid: A case report

Ear keloid is one of the more common forms of keloid, which may cause pain and itching, and is aesthetically unappealing. Recurrence is common with any monotherapy which prompted a comprehensive, multidimensional approach. A 24-year-old female was evaluated in our department on April 6, 2021, due to an "8-year recurrence following a left ear keloid resection." In July 2013, a left auricle keloid excision was performed in a local hospital. One year following the operation, the scar at the surgical site had proliferated, gradually spreading beyond the original scar borders. Patients worry about recurrence after surgery affecting the appearance of the ear. Ear keloid. The patient underwent a 2-stage re-resection of the keloid, followed by postoperative radiotherapy, and triamcinolone acetonide injection around the incision at the time of the second operation. Finally, silicone gel was applied for antiscar treatment. There has been no postoperative recurrence of ear keloid during the 12-month follow-up. For ear keloids, combination therapy offers an improved approach with an excellent aesthetic appearance and less risk of recurrence than traditional monotherapy.