Papers of The 1st Japan Scar Workshop

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

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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