OBJECTIVE: To review the research progress of the principle and clinical application of keloid core excision technique. METHODS: The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed. RESULTS: Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies. CONCLUSION The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.
Humans ; Keloid/pathology* ; Recurrence ; Surgical Flaps/pathology* ; Plastic Surgery Procedures ; Treatment Outcome

OBJECTIVE: Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue following an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy (HBOT) to reduce the keloid recurrence rate after surgical excision and radiotherapy. METHODS: (1) A total of 240 patients were randomly divided into two groups. Patients in the HBOT group (O group) received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy (K group). (2) Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin (H&E) staining was used to observe keloid morphology. Certain inflammatory factors (interleukin-6 (IL-6), hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-α (TNF-α), nuclear factor κB (NF-κB), and vascular endothelial growth factor (VEGF)) were measured using immunohistochemical staining. RESULTS: (1) The recurrence rate of the O group (5.97%) was significantly lower than that of the K group (14.15%), P<0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group (P<0.05). (2) Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group. CONCLUSIONS Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.
Adolescent ; Adult ; Female ; Humans ; Hyperbaric Oxygenation ; Hypoxia-Inducible Factor 1, alpha Subunit/blood* ; Inflammation ; Interleukin-6/blood* ; Keloid/surgery* ; Male ; Middle Aged ; NF-kappa B p50 Subunit/blood* ; Perfusion ; Recurrence ; Surveys and Questionnaires ; Tumor Necrosis Factor-alpha/blood* ; Vascular Endothelial Growth Factor A/blood* ; Young Adult

Management of incisional scar is intimately connected to stages of wound healing. The management of an elective surgery patient begins with a thorough informed consent process in which the patient is made aware of personal and clinical circumstances that cannot be modified, such as age, ethnicity, and previous history of hypertrophic scars. In scar prevention, the single most important modifiable factor is wound tension during the proliferative and remodeling phases, and this is determined by the choice of incision design. Traditional incisions most often follow relaxed skin tension lines, but no such lines exist in high surface tension areas. If such incisions are unavoidable, the patient must be informed of this ahead of time. The management of a surgical incision does not end when the sutures are removed. Surgical scar care should be continued for one year. Patient participation is paramount in obtaining the optimal outcome. Postoperative visits should screen for signs of scar hypertrophy and has a dual purpose of continued patient education and reinforcement of proper care. Early intervention is a key to control hyperplastic response. Hypertrophic scars that do not improve by 6 months are keloids and should be managed aggressively with intralesional steroid injections and alternate modalities.
Cicatrix/*prevention & control/surgery ; Cicatrix, Hypertrophic/prevention & control ; Humans ; Keloid/prevention & control/radiotherapy ; Sebaceous Glands/physiology ; Skin/physiopathology ; Wound Healing

OBJECTIVETo investigate the treatment of auricular keloid with dinuclear surgery and intralesional injection of compound Betamethasone.

METHODSFrom Jan. 2008 to Jan. 2012, a total of 186 cases of ear keloid were treated by surgery only (22 cases), or intralesional injection of compound Betamethasone (34 cases), or combined dinuclear surgery with compound Betamethasone (130 cases). All the patients were followed up for one year. SPSS 16.0 software was used for statistical processing and analysis, and GraphPad inspection method for inspection.

RESULTSThe effective rate was 54.55% (12/ 22) in surgery group and 55.88% (19/34)in injection group. The recurrence was obvious in injection group during the follow-up period. The effective rate was as high as 96.92% (126/130) in combined group with recurrence in 4 cases, which was significantly higher than that in other 2 groups (P < 0. 01).

CONCLUSIONCombined dinuclear surgery and compound Betamethasone injection has a good therapeutic effect on auricular keloids.

Adolescent ; Adult ; Betamethasone ; therapeutic use ; Combined Modality Therapy ; Ear Auricle ; pathology ; Female ; Humans ; Injections, Intralesional ; Keloid ; surgery ; therapy ; Male ; Treatment Outcome ; Young Adult

OBJECTIVETo investigate an individualized approach to the treatment of auricle keloid to maintain the normal appearance of external ear and meanwhile reduce the recurrence.

METHODSDifferent local flaps were performed according to the location of the keloid in our approach. The auricle was divided into different anatomical regions and all the patients received local postoperative radiotherapy.

RESULTSOf 68 patients with auricle keloid received the individualized approach, 3 cases suffered delayed healing due to partial flap necrosis. The remaining patients were followed up for 8-21 months(mean:11.5 months) . Recurrence occurred in one patient(1.47%) .

CONCLUSIONThe individualized approach combining local flaps with radiotherapy in treating auricle keloid can effectively maintain the normal ear appearance with low recurrence rate.

Adult ; Ear, External ; surgery ; Female ; Follow-Up Studies ; Humans ; Keloid ; radiotherapy ; surgery ; Male ; Radiotherapy, Adjuvant ; Recurrence ; Surgical Flaps ; Young Adult

We report the outcome of conventional epipolis laser in situ keratomileusis (Epi-LASIK, flap-on) and lamellar epithelial debridement (LED; Epi-LASIK, flap-off) in myopic patients with dermatologic keloids. Three patients, who were all noted to be susceptible to keloid scarring, received conventional Epi-LASIK in their right eyes and LED in their left eyes. The patients were followed-up for 6 to 21 months after their surgeries, and the outcomes were then evaluated. In case 1, the preoperative spherical equivalent (SE) was -6.5 diopters (D) in the right eye (OD) and -6.25 D in the left eye (OS). At 21 months postoperatively, the uncorrected visual acuity (UCVA) was 20 / 12.5 in both eyes. In case 2, the preoperative SE was -5.25 (OD) / -6.00 (OS). After six months, the postoperative UCVA was 20 / 12.5 in both eyes. In case 3, the preoperative SE was -4.5 (OD) / -2.0 (OS). The UCVA at the six-month follow-up was 20 / 12.5 in both eyes. No adverse events, including corneal haze, occurred in any of the patients. All three of our patients reported excellent visual outcomes following both conventional Epi-LASIK and LED, despite their histories of keloid formation. The present cases suggest that both Epi-LASIK and LED may be safe and effective techniques for myopic patients with dermatologic keloids.
Adult ; *Debridement ; Eyeglasses ; Female ; Follow-Up Studies ; Humans ; Keloid/complications/physiopathology/*surgery ; Keratomileusis, Laser In Situ/*methods ; Myopia/complications/physiopathology/*surgery ; Postoperative Period ; Skin Diseases/complications/physiopathology/*surgery ; Treatment Outcome ; Visual Acuity

PURPOSE: To describe a case of unilateral corneal keloid and present the clinical and histopathological findings and the management. METHODS: A 23-year-old Asian male patient was examined for a white spot on the left cornea that had been present since birth. On biomicroscopic examination, a well-demarcated vascularized corneal mass was found located nasal to the center. The pupil was displaced superiorly, and gonioscopic examination showed peripheral iridocorneal adhesion at 12 o'clock. The patient underwent penetrating keratoplasty. RESULTS: Histopathologic study showed a variously thickened epithelial layer, an absence of Bowman's layer, subepithelial fibrovascular hyperplasia, and an absence of dermal elements. These histopathologic findings suggested a congenital corneal keloid. The central graft cornea remained clear at 18 months after surgery and the patient was satisfied with the result. CONCLUSIONS: Penetrating keratoplasty may be an effective surgical option for congenital keloids in young adult patients.
Adult ; Corneal Diseases/*congenital/*pathology/surgery ; Humans ; Keloid/*congenital/*pathology/surgery ; Keratoplasty, Penetrating ; Male

OBJECTIVETo explore the effectiveness of postoperative electron beam irradiation therapy for keloid.

METHODSForty-eight patients with 65 keloid sites were treated by surgical removal and postoperative 25 Gy electron beam irradiation from 1994 to 2002 and followed for over eighteen months. Statistical analysis was performed and therapeutic outcome was evaluated.

RESULTSThe overall recurrence rate was 26%. Higher post-treatment recurrence rates were noted with keloid forming at infected sites and in patients with family history (47.8% and 53.3%) (P < 0.05). Meanwhile, patient age, sex, keloid size and location had no increased likehood of recurrence rate.

CONCLUSIONThe study shows that postoperative electron beam irradiation therapy is a kind of safe and effective method in inhibiting recurrence of keloid formation and eradicating it.

Adult ; Combined Modality Therapy ; Electrons ; Female ; Follow-Up Studies ; Humans ; Keloid ; radiotherapy ; surgery ; Male ; Postoperative Care ; Recurrence ; Treatment Outcome

OBJECTIVETo introduce a new technique for the treatment of helical keloid.

METHODSThe procedure consisted of two steps. In the first step, a kidney-shaped expander of 50 ml was placed subcutaneously in the retroauricular area. Routine inflation with normal saline followed. In the second step, about two months afterwards, the expander was taken out and the helical keloid was excised. The expanded flap was advanced to cover the wound.

RESULTSThe operation has been performed on 12 patients of 16 sites of helical keloid since 2000. Postoperative follow-up from 3 months to 2 years revealed satisfactory results. The reconstructed ear maintained a good contour.

CONCLUSIONThe technique creates a retroauricular flap rich in blood supply, which can be used to close the defect left by helical keloid excision. It provides a good treatment for the helical keloid replaced with normal skin from the mastoid region.

Adolescent ; Adult ; Child ; Ear ; abnormalities ; surgery ; Female ; Humans ; Keloid ; surgery ; Male ; Surgery, Plastic ; methods ; Treatment Outcome