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Papers of The 1st Japan Scar Workshop |
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16. Combined Surgical Excision and Radiation Therapy is
Efficient for Keloid Treatment
Akita S, Hirano A
Division of Plastic and Reconstructive Surgery, Department of
Developmental and Reconstructive Medicine, Nagasaki University, Graduate
School of Biomedical and Sciences, Nagasaki, Japan
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Various methods have been tried for the treatment and management of
keloids; however, there is little satisfactory clinical evidence on
long-term follow ups. Usually anatomical locations with higher than
normal regional tension and more sebaceous glands are inclined toward
pathogenesis. Thirty-eight keloids treated with combined surgical
excision and post-operative irradiation, using electron beams with only
10-mm opening by lead shielding, were investigated at a mean follow-up
of 4.4 ± 2.5 years (1 to 9 years) at a single institute. Ten locations,
such as the ear (n=6), neck (n=3) and upper lip (n=1), were among the
craniofacial sites. Hardness of the keloids and post-treatment scars
were clinically and objectively tested with the Vancouver scar scale and
a durometer, which is often used for industrial measurement of
thread-balls and rubber. At a mean of 4.4 ± 2.5 years of follow-up, the
clinical characteristics of the scars were significantly better
post-treatment with the readings at 2.6 ± 0.5 vs. 1.0 ± 0.6, 3.7 ± 0.7
vs. 1.7 ± 0.7, 2.9 ± 0.4 vs. 1.3 ± 0.5 and 2.7 ± 0.5 vs. 1.3 ± 0.5 (keloid
scars vs. post-treatment scars pigmentation, pliability, height and
vascularity, respectively, P<0.01). The relative durometer readings were
significantly lower post-treatment as shown, 15.2 ± 3.9 vs. 7.7 ± 2.9 (keloid
scars vs. post-treatment scars, P<0.01). The recurrence rate was 21.2 %
overall. Therefore, the combined treatment of surgical excision and
post-operative electron-beam irradiation is effective for scar quality
and reducing the recurrence rate in long-term follow-up. |
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