Excision Technique Research Articles

Mycorrhization and root excision effects on morphological and biomass production of carob (Ceratonia siliqua L.)

Ceratonia siliqua L. plant (carob tree) is a Mediterranean species. In Tunisia, natural distribution of this species is situated in humid zones in the north to the driest ones in the south of the country. Ceratonia siliqua regeneration depends on seeds quality and performances as well as on the practical vegetative propagation tools. Nowadays, carob tree cultivation is limited by the seedlings quality behind the juvenile stage caused by the deterioration of plant root system. This study investigates the effect of lone and mutual root excision technique and mycorrhization on carob seedlings growth performance. Two carob seeds origins were germinated then excised and/or mycorrhized using a sterile substate. For control seedlings, experiment was made without excision nor mycorrhization application. Seedlings were grown in green house. Mycorrhizae applied with excision ameliorated significantly plant length, leaf number, dry and fresh weight of external plant part and roots, collar root diameter and roots branching numbers. Survey of mycorrhizae effects proved also amelioration on carob growth and biomass production but indiscernibly than use of mycorrhization and excision techniques together. Excision alone does not take a part on seedling increasing performance. Mycorrhization of carob species applied with excision increased morphological plant status. Results highlighted the efficiency to use this process to promote plants behaviour by enhancing plant roots and growth in forest farming model in forest areas and agricultural lands.

Vaginoscopic Management of OHVIRA (Obstructive Hemivagina and Ipsilateral Renal Agenesis)

To describe the vaginoscopic management of longitudinal vaginal septum in the case of obstructive hemivagina and ipsilateral renal agenesis (OHVIRA) syndrome. Surgical video describing step-by-step management. OHVIRA syndrome also known as Herlyn-Werner-Wunderlich syndrome is a triad of obstructed hemivagina, uterus didelphys, and ipsilateral renal anomaly [1] (Supplimentary Video 1). Patients usually present after menarche with progressive dysmenorrhea, lower abdominal pain, a paravaginal mass, foul mucopurulent discharge, and intermenstrual bleeding due to hemi hematocolpos [2]. Magnetic resonance imaging is the choice of investigation [3]. Surgical resection of the septum is the choice of treatment, which can be done vaginoscopically to reduce postoperative pain and promote enhanced recovery [4]. In this video, we will demonstrate a case of a 28-years old, nulliparous woman diagnosed with uterine didelphys having lower abdominal pain and persistent vaginal discharge. The video demonstrates the technique of vaginoscopic excision of the right hemi-vaginal septum that resulted in complete visualization of both cervices. Diagnostic laparoscopy confirmed uterine didelphys. The left cervix was visualized and the hysteroscope was negotiated into the cervical canal (Supplimentary Video 2). The left cavity was normal with left ostia. Intraoperative transrectal-ultrasound was done to localize the cystic collection in the right hemivagina. Needle aspiration of cystic collection was done over the bulging portion of the right hemivagina and mucoid material was aspirated. Longitudinal obstructive vaginal septum was incised using a collins knife and mucoid secretions were drained (Supplimentary Video 3). Hysteroscope inserted into opened right hemivagina, negotiated through the right cervix and right hemiuterus with right ostia was visualized. The residual septum was resected with a loop electrode and hemostasis was ensured. Cystoscopy done, left ureteric orifice with urine reflux visualized. Vaginal examination showed both cervices with near normal reconstructed vagina. The possibility of OHVIRA syndrome should be considered in all cases of uterine didelphys. Vaginoscopic management is a safe and effective method with a minimally invasive approach.

Robotic assisted rectal disk excision: the 3-cm diameter cut off may be abandoned

To describe the robotic full-thickness rectal excision using a transanal circular stapler in rectovaginal endometriosis nodule infiltrating the rectum >3 cm. Surgical video article. The local institutional review board was consulted, and the requirement for institutional review board approval was waived because the video describes a technique and the patient cannot be identified whatsoever. Written informed consent was obtained from the patient for the use of personal data. A tertiary referral center. Patients undergoing excision of rectal endometriosis. Standardized technique of full-thickness disk excision of large rectovaginal endometriosis nodules employing a combined robotic and trans anal approach. Feasibility of the technique. The technique is designed for deep rectovaginal nodules infiltrating middle and low-rectum up to 3 to 5 cm in length. The procedure was performed with robotic assistance. The 7-degree freedom mobility of the robotic scissors allows for a deep rectal shaving, with the goal of progressive reduction of the thickness of rectal wall. The scissors follow the rectal wall tangentially and leave behind a thin rectal wall which can be bent and pushed into the trans anal stapler's jaws. We employed end-to-end, 33 mm-diameter, circular trans anal staplers to increase the area of rectal wall to be caught into the stapler. A stitch was placed on the superior and the inferior limits of the shaved area, then the shaved area was bent and pushed into the stapler by tying a suture. The general surgeon closed and fired the stapler, then the stapler was removed together with a rectal patch of 4- to 6-cm diameter. The procedure ended in the bubble test which checked the integrity of the stapled line. Supplementary stitches may be placed to reinforce the suture, if required. The preliminary rectal shaving represents the real keystone of this procedure, and our experience suggests that the robotic assistance improves its feasibility in large nodule responsible for intrarectal protrusion.

A comparison of ICG-NIR with blue dye and technetium for the detection of sentinel lymph nodes in vulvar cancer.

The sentinel lymph node (SLN) procedure for vulva cancer is a safe alternative to a radical inguino-femoral lymphadenectomy (IFLN) for small unifocal tumours. SLN evaluation through biopsy and ultra-staging has helped gynaecological oncology surgeons improve operative morbidity with no cost to oncologic safety. Established techniques for groin SLN detection and excision in vulvar cancer use 99mTc-nanocolloid radiotracer and blue dye (BD) for identification of the SLN. Indocyanine green (ICG)-near infrared (ICG-NIR) techniques for SLN mapping have proven utility in other gynaecological cancer sites and is gaining interest as a technique for SLN mapping in vulvar cancer METHODS: Fifty consecutive patients with unifocal vulvar squamous cell cancers of <40mm lateral diameter and with depth of invasion > 1mm underwent SLN mapping and excision using a combination of 99mTc-nanocolloid, BD and ICG. SLN detection results were recorded on a per-patient and per-groin basis. The success rates SLN for detection by individual tracer substance or combinations of tracer were determined by presence of one or more tracer, detectable in the SLN specimen. 92% of patients had a successful SLN procedure. The per-groin detection rate was 84%. All successfully mapped SLN were identified with the combination of ICG-NIR and 99mTc-nanocolloid compared to 69% with BD 99mTc-nanocolloid. Success rates for the SLN procedure were not dependent on prior excision of the primary lesion or operator experience. Incorporation of ICG-NIR into standard SLN mapping protocols may allow for the abandonment of routine use of BD and its poor side effect profile.

Assessment of association between lower ureteric excision technique and oncological outcomes for upper urinary tract urothelial carcinoma: retrospective analysis from the Scottish Renal Cancer Consortium

PurposeNephroureterectomy(NU) remains the gold-standard surgical option for the management of upper urinary tract urothelial carcinoma(UTUC). Controversy exists regarding the optimal excision technique of the lower ureter. We sought to compare post-UTUC bladder tumour recurrence across the Scottish Renal Cancer Consortium(SRCC).MethodsPatients who underwent NU for UTUC across the SRCC 2012–2019 were identified. The impact of lower-end surgical technique along with T-stage, N-stage, tumour location and focality, positive surgical margin, pre-NU ureteroscopy, upper-end technique and adjuvant mitomycin C administration were assessed by Kaplan–Meier and Cox-regression. The primary outcome was intra-vesical recurrence-free survival (B-RFS).ResultsIn 402 patients, the median follow-up was 29 months. The lower ureter was managed by open transvesical excision in 90 individuals, transurethral and laparoscopic dissection in 76, laparoscopic or open extra-vesical excision in 31 and 42 respectively, and transurethral dissection and pluck in 163. 114(28.4%) patients had a bladder recurrence during follow-up. There was no difference in B-RFS between lower-end techniques by Kaplan–Meier (p = 0.94). When all factors were taken into account by adjusted Cox-regression, preceding ureteroscopy (HR 2.65, p = 0.001), lower ureteric tumour location (HR 2.16, p = 0.02), previous bladder cancer (HR 1.75, p = 0.01) and male gender (HR 1.61, p = 0.03) were associated with B-RFS.ConclusionThese data suggest in appropriately selected patients, lower ureteric management technique does not affect B-RFS. Along with lower ureteric tumour location, male gender and previous bladder cancer, preceding ureteroscopy was associated with a higher recurrence rate following NU, and the indication for this should be carefully considered.

Update on Upper Limb Neuroma Management.

Painful terminal neuromas in the upper limb due to nerve injury are common. Neuroma symptoms include a sharp and burning sensation, cold intolerance, dysesthesia, pain, numbness, and paresthesia. These symptoms could have a negative impact on the functional ability of the patient and quality of life. In addition, Prostheses use might be abandoned by amputees due to neuroma-induced pain. Many clinicians face challenges while managing neuromas. Contemporary "active" methods like regenerative peripheral nerve interface (RPNI), targeted muscle reinnervation (TMR), and processed nerve allograft repair (PNA) are replacing the conventional "passive" approaches such as excision, transposition, and implantation techniques. RPNI involves inducing axonal sprouting by transplanting the free end of a peripheral nerve into a free muscle graft. TMR includes reassigning the role of the peripheral nerve by the transfer of the distal end of a pure sensory or a mixed peripheral nerve to a motor nerve of a nearby muscle segment. To give the peripheral nerve a pathway to re-innervate its target tissue, PNA entails implanting a sterile extracellular matrix prepared from decellularized and regenerated human nerve tissue with preserved epineurium and fascicles. Of these, RPNI and TMR appear to hold a promising treatment for nerve-ending neuromas and prevent their relapse. In contrast, PNA may reduce neuroma pain and allow meaningful nerve repair. The aim of this article is to provide an overview of the newer approaches of TMR, RPNI, and PNA and discuss their implications, surgical techniques, and reported consequences.

Management of complex urethral stricture in public health facilities in developing nations in the 21st century

Management of complex urethral stricture in public health facilities in developing nations in the 21^st century

Osteoid Osteomas of Spine: From Open to Minimally Invasive Excision of the Nidus – A Case series

Osteoid osteomas of spine are not uncommon and majority of which occurs in posterior elements of lumbar spine. Management of such lesions in spine ranges from open en bloc excision to percutaneous radiofrequency ablation. In this series, we have managed three cases of osteoid osteomas of spine, each managed differently from conventional open technique to minimally invasive method. All three cases underwent appropriate radiological investigations and followed by surgical excision of the lesion and histopathological analysis post-operatively. First case was managed with open excision of the lesion with conventional unilateral pedicle screw stabilisation. Second case, who underwent open excision of the lesion developed recurrence which was managed by re-excision without any further complications. Last case underwent microendoscopic quadrant tubular excision of the tumour with unilateral MISS with pedicle screws. The technique of Microendoscopic quadrant tubular excision of posterior element benign tumour had advantages of small skin incision, less bleeding, clear macroscopic visualisation of the small tumour (enables complete excision of the nidus thus decreasing the recurrence), early mobilisation and shorter hospitalization with effective and complete excision of the tumour better than open method. Further, histological evidence of tumour will be available. The complete excision of nidus using microendoscopic tubular retractors with unilateral fixation in young age gives encouraging results. This case series is followed by review of literature highlighting the role of COX-2 inhibitors in osteoid osteoma, cause for scoliosis and neurological deficit in osteoid osteoma and management of osteoid osteomas of spine. Keywords: Tumor, Osteoid osteoma, Minimally invasive, Dorsolumbar spine, Excision biopsy

Laparoscopic management of symptomatic urachus remnants in adults: A retrospective study.

To report our experience in the laparoscopic management of symptomatic urachal remnants (URs) in adults. A retrospective study included all patients who underwent laparoscopic excision of URs during the period January 2015-January 2020. The following data were retrieved from the files of the patients: demographic data, clinical presentations, intra-operative findings, the procedure performed, operative details, intraoperative or post-operative complications and follow-up period mentioned in the files for those patients. The study included 10 patients (four males and six females) with a mean age of 27.8 ± 11.0 years. URs were discovered preoperatively in all patients except one patient who was diagnosed intraoperatively. URs were associated with other pathologies in four patients (40%) that required two simultaneous surgical procedures. Eight patients (80%) presented with simple umbilical discharge and were diagnosed easily by ultrasonography. All patients were managed successfully with laparoscopic excision and umbilical sparing technique. Excision of the dome of the bladder was done on the selective approach to one patient. No patients showed early post-operative complications. Only one patient had stitch sinus 6 months postoperatively due to a concomitant hernia repair rather than due to the excision of the URs. Laparoscopic excision of symptomatic urachus is a feasible procedure even when the excision of the bladder is required. It could be performed successfully with other pathologies. It is associated with a low incidence of complications. Laparoscopy allows good visualisation and complete excision that leads to almost no recurrence rate.

Rhinoethmoidal mixt cavernous-capillary hemangioma – endoscopic transnasal resection. Case report

Hemangiomas are benign vascular tumors which originate in the skin, mucosae and deep structures such as bones, muscles or glands. Hemangiomas have capillary, cavernous, mixed, and hypertrophic subtypes. These neoplasms rarely arise in the nasal cavity, and when they appear here, they are predominantly capillary and are found attached to the nasal septum. Cavernous hemangiomas, on the other hand, are more likely to be found on the lateral wall of the nasal cavity. This article presents a case of a mixt cavernous-capillary hemangioma, arising from the mucosa of the posterior and superior nasal septum, in a 62-year-old female, successfully treated by the transnasal endoscopic excision technique.

Non-multiple medium-sized congenital melanocytic nevi: to excise or to follow up?

Congenital melanocytic nevi (CMN) are benign lesions composed of clonal proliferations of melanocytes. Although medium-sized CMN are common and generally remain benign throughout a person's lifetime, they may be precursors of melanoma. There is a limited number of studies focused on the risk of melanoma in solitary, medium-sized, congenital melanocytic nevus; therefore, the incidence of malignant transformation and guidelines for treatment are not well established. Prompted by the limited data, we conducted this study to gather more information about medium-sized CMN, to optimize clinical care. We share our analysis of surgically removed medium-sized CMN. A total of 10 patients with non-multiple, medium-sized, congenital melanocytic nevus were included in this study. Lesions were removed using surgical procedures. In most of the cases the reason for excision of the medium-sized CMN was evolution of the lesion or aesthetic considerations reported by the patients. In 2 cases, due to the large size of the lesions, serial excisions were performed, while other CMN were removed surgically using simple excision technique. Eight of 10 medium-sized CMN were histologically described as benign, and 2 cases of malignant transformations were reported. According to our clinical experience and knowledge, we recommend managing patients on an individual basis, taking into consideration multiple clinical attributes. In our opinion, long-lasting observation is the management of choice, and if there is need of surgery, we recommend total simple or staged excision depending on nevus size.

Perinatalne komplikacije nakon ekscizionog lečenja cervikalne displazije

Cervical cancer is one of the most common malignant tumors in women. Mass screenings have significantly decreased its incidence, while causing an increase in precancerous cervical lesions that are mainly diagnosed in women of reproductive age who still have not fulfilled their reproductive goals. The aim of surgical treatment of these premalignant lesions is to prevent the development of cervical cancer, with minimal risks to the reproductive function. The most important perinatal complication is preterm delivery, usually coupled with preterm premature rupture of the membranes and chorioamnionitis. This results in prematurity with low birth weights, which can further result in increased neonatal morbidity and mortality. Data on the incidence of spontaneous miscarriages in treated women are non-consistent , however, it is believed that the incidence is higher in the second trimester. Possible predictors of complications are the amount of excised tissue, the type of excision technique, age at the time of surgery, and the length of the period between treatment and conception. Re-excision of the cervix is an additional risk factor for perinatal complications. The risk of perinatal complications is the highest after cold knife conization, followed by laser conization, whereas LEETZ excision means the lowest risk-this is primarily explained by the variations in the cone size. Having in mind that not all precancerous cervical lesions progress to cancer and that all types of excision treatments are associated with an increased incidence of perinatal complications, an adequate approach would entail primarily well-selected patients, i.e., treating only those women who are at real risk of developing cancer. The surgical treatment must be adapted to provide minimal risks for perinatal complications, maximal oncologic safety , and minimal risk of residual and/or recurring disease during a woman's lifespan.

Liposuction versus Periareolar Excision Approach for Gynecomastia Treatment.

Gynecomastia (GM) is the increased fibroglandular tissue in the male breast by more than 2 cm, which is palpated under the nipple and areola. An ideal surgical approach aims to reduce the breast size, reach an acceptable breast shape, resect excessive glandular tissue, fatty tissue, and skin fatty tissue and excess skin, relocate the nipple-areolar complex, and avoid scars. Based on its importance, we aimed to compare outcomes of liposuction with and without periareolar incision in patients with GM. This was a randomized clinical trial on patients referred for plastic surgery. Patients with GM were allocated into two treatment groups. Group A underwent liposuction without any areolar skin incision and group B had liposuction with the areolar skin incision. Patients were followed-up after surgery. Data were analyzed by Statistical Package for the Social Sciences (SPSS) version 20. Sixty patients aged between 20 and 27 years old participated in this study. Three hematomas, two surgical site infections, one nipple hypopigmentation after surgery, and one seroma formation were noted in group B. On the other hand, one hematoma and one seroma formation were noted in group A. The patients in group A were highly satisfied after the liposuction without skin incision procedure compared with group B (P = 0.01). The management of GM by liposuction, either with the periareolar excision technique or without skin incision, allows the effective removal of fat and glandular tissue of the male breast. Although there was no significant difference regarding postoperation complications between groups, patients' satisfaction should be considered.

Excision and reconstruction of port site umbilical endometrioma; practices of aesthetic gynaecology in a low resource setting

The presence of endometrial tissues outside the uterine cavity is known as endometriosis. Villar’s node, also known as umbilical endometriosis, is a rare condition that accounts for 0.5-1% of all extra-pelvic diseases. Electrocautery combined with surgical removal of the umbilical nodule and a recreation of an aesthetically appealing umbilicus is the treatment of choice. The surgical technique of local excision of umbilical endometrioma, neo umbilical reconstruction with four flap technique and post-operative management in low resource settings where plastic surgery facilities are not available have been discussed in the article.

Deep Margins Melanoma: How Deep Is Deep Enough?

Wide excision (WE) to muscular fascia for invasive melanoma is common practice but excision to subcutaneous tissue may be adequate. We evaluated practice patterns regarding depth of biopsy and excision as well as risks for recurrence. Retrospective review of patients with pT1-4 melanoma (cN0) treated with WE at a single institution was performed. Patient factors were evaluated. Biopsy and excision techniques were compared to pathology and reviewed for recurrence. 385 patients from 2006 to 2020 were included. Lesions were on the extremity (n = 189), head/neck (n = 48), trunk (n = 148). Biopsy techniques included shave (n = 330), excisional (n = 36), punch (n = 10), incisional (n = 9). Deep biopsy margins were positive for IM/melanoma in situ in 139 patients. WE specimens were taken to muscular fascia (n = 218) or mid/deep fat (n = 144). 51 patients had recurrent disease or a new primary lesion: locoregional (n = 31), distant (3), or new lesions (n = 17). Patient characteristics associated with recurrence include older age and female gender. Tumor characteristics associated with recurrence include lesions located on the trunk, superficial spreading melanoma, ulceration, perineural invasion, and clinical T and P stage. Patients that recurred were more likely to have WE taken to or including muscular fascia. Biopsy type, deep margin on biopsy, and depth of dissection was not associated with recurrence.

“Scarless” excision of a nipple adenoma case report—a good aesthetic outcome after a circular nipple excision with purse-string closure technique

: Complete surgical excision of nipple adenoma with clear margins offers the lowest risk of recurrence of this locally infiltrative yet benign entity. A thorough triple assessment including histological assessment is crucial to exclude any malignant pathology, and confirm the diagnosis. There are many excisional and ablative techniques published that can give clear resection margins, but there remains a paucity of data on acceptable aesthetic outcomes. It is important to balance between adequate surgical margins to prevent recurrence and a good aesthetic outcome, particularly in a young patient. We wish to highlight a good aesthetic outcome following a simple circular excision with purse-string closure of the nipple defect. We present a 28-year-old lady with a progressively ulcerative lesion that involved the entire nipple. Ultrasound did not show any other underlying lesions or intraductal extension. Punch biopsy confirms the diagnosis of a benign nipple adenoma. She was counselled for complete nipple excision and the defect was primarily closed with purse-string technique. This may not be a novel technique as it has been described for closure of other defects. However, the benefit of a purse-string closure of a circular nipple excision defect to reduce scarring may be underreported in the literature. This technique helps to conceal the scar within the areola, retain its natural corrugated appearance, and prevent distortion to the overall shape of the areolar complex. The final outcome of a complete nipple excision resembles that of a ‘scarless’ excision and remains aesthetically pleasing. We hope to allay fears of clinician and patients faced with similar condition by offering a safe, easily reproducible, single staged technique that offers high patient satisfaction in selected patients. Using this technique may even preclude the need for further nipple reconstruction.

The Five Ds for Safe and Effective Buccal Fat Removal.

An aesthetically sculpted malar, cheek, and jawline contour is a desirable feature sought out by many adults with central facial adiposity. This fullness, anterior to the masseter, can be attributed to underlying buccal lipodystrophy. An attractive central facial concavity can be delivered by performing buccal fat pad excision in conjunction with malar fat pad augmentation and mandibular contouring if indicated. Appropriate patient selection is critical for preventing an aged or unnatural appearance. The authors present a safe and reliable five-step technique for buccal fat pad excision: the Five Ds.

Laparoscopic Discoid Excision of Bowel Endometriosis Using Sutures for Closure

To demonstrate the technique of discoid excision of bowel endometriosis followed by closure of the bowel defect using sutures, without the application of the transanal stapler device. Stepwise demonstration of the technique with narrated video footage. Bowel endometriosis is a common pattern of deep endometriosis [1]. Discoid excision is 1 of the 3 surgical interventions applied to manage this pathologic entity, with shaving and segmental resection being the other 2 [2]. When discoid excision is performed, a transanal stapler device is used for bowel closure in most cases [3,4]. Only a few studies so far have reported the application of sutures for this purpose [5]. This video highlights the technique of bowel suturing after discoid excision. This video presents the technique of bowel discoid excision with the application of sutures to close the bowel defect (Supplemental Video 1). The key surgical steps are as follows: 1. Dissection of both ureters and development of pararectal spaces. 2. Recognition and preservation of the inferior hypogastric plexus and the hypogastric nerve. 3. Detachment of the nodule from the cervix. 4. Detachment of the nodule from the bowel, beginning with deep shaving and followed by discoid excision. 5. Thorough description of the bowel closure using 2 layers of Vicryl 3-0 sutures, the first being interrupted and the second continuous. The described technique of bowel closure using sutures may be a safe and effective alternative to the transanal stapler. Its advantage is that it can be performed when the pathology is located higher than 15 cm from the anal verge or the diameter of the nodule is more than 30 mm.

Reconstruction of polysyndactyly of the fused fifth toe with the fourth toe.

Polysyndactyly of the fused fifth toe with the fourth toe is a common subtype of postaxial polydactyly. The aim of the study was to present an operative technique for cosmetic improvement and reconstruction of polysyndactyly of the fused fifth toe with the fourth toe. We retrospectively reviewed the details of 22 patients with postaxial polydactyly treated from January 2018 to May 2021. The operation involved medial toe excision and web space reconstruction using a dorsal rectangular flap without skin grafting and simultaneous correction of a valgus deformity by chondroplasty and soft tissue balancing without an osteotomy. The web shape, scar, and aesthetic outcomes were evaluated on the criteria of the D'Arcangelo, Vancouver Scar Scale score, and satisfactory questionnaire, respectively. The patients were followed up for 7-43 months. At the last follow-up, valgus deformity was completely corrected without recurrence. On the basis of the criterion of D'Arcangelo, the height and width of the webs were good in 24 of the feet, fair in four of the feet, and poor in none of the feet. The mean Vancouver Scar Scale score was 1.55. All parents and patients were satisfied with the appearance and function. The described medial toe excision technique and reconstruction of the web space without a skin graft corrected the valgus deformity and were able to satisfy functional and cosmetic requirements.

Management of Earlobe Keloid by Triple Combination Therapy (Core Excision, Fillet Flap, and Intralesional Corticosteroids): A Case Report

Background: Keloid is a growing neoplasm characterized by the proliferation of benign fibroblasts. The chest, shoulders, head, especially the ear lobes, neck, arms, and upper back are the areas most commonly affected by keloids. The use of a fillet flap allows dissection of the keloid core and leaves loose skin for wound closure. This study aims to describe the surgical management of keloids in the auricular region using the core excision technique with a keloid fillet flap with a combination of corticosteroid injections.&#x0D; Case presentation: A 54-year-old man came with the main complaint of a red lump with hard consistency and itching on the right ear. The management of this patient was surgery using the core excision technique with a keloid fillet flap followed by intra-operative intralesional and immediate post-operative corticosteroid injection and then programmed for corticosteroid injection at the next follow-up. Post-operative therapy was given cefixime 2x100mg and oral analgesic mefenamic acid 3x500mg for 5 days.&#x0D; Conclusion: Keloid surgery is the treatment of choice because it produces good cosmetic results quickly. Routine follow-up and additional therapy are required to prevent a future post-operative recurrence.