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11. Management and Outcome of Combination Therapy by Surgical
Excision and Irradiation for Keloids
Yanagisawa Akira1, Hashikawa Kazunobu1, Kemmoku
Kazutaka2, Terashi Hiroto1, Yoshida Kenji3,
Tahara Shinya1
1:Department of Plastic Surgery, Kobe University Graduate School of
Medicine, Hyogo, Japan
2:Department of Plastic Surgery, Sanda City Hospital, Hyogo, Japan
3:Department of Radiology, Kobe University Graduate School of Medicine,
Hyogo, Japan
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There is no consensus for the best way to treat refractory keloids
because of the small number of studies on the subject. Combination
therapy by surgical excision followed by irradiation is considered the
most efficacious method for treating such keloids. Between 2001 and
2006, 31 keloids in 26 patients were selected and studied at Kobe
University Hospital. The keloids were surgically removed. Some (15/31)
were treated postoperatively with 20 Gy electron-beam irradiation, and
all were followed up for more than 12 months. The therapeutic outcome
was evaluated by classification into a recurrence group and a
no-recurrence group. The recurrence rate in the external ear (including
the auricle and the ear lobe) was 8.3% (1/12) after excision only and
16.7% (1/6) after excision followed by irradiation. The recurrence rate
at other sites was 100% (4/4) after excision only and 66.7% (6/9) after
excision followed by radiation therapy. Excision might be sufficient for
the treatment of keloids in the external ear, at least primarily. On the
other hand, excision followed by irradiation is required for the
treatment of keloids at other sites, and more than 20 Gy irradiation
might be desirable in some cases. |
