Purpose:

Keloids represents an excessive tissue response to dermal injury characterized by local fibroblast proliferation and overproduction of collagen. These scars may cause functional impairment, cosmetic disfigurement and result in poor quality of life. Many literatures report several treatments for keloids including compressive therapy, adhesive tape support and intralesional corticosteroid injections. However, treating keloids is still very challenging due to its high recurrent rate and lack of gold standard of treatment. Currently, adjuvant radiotherapy followed by surgical excision has found to be effective in managing keloids and preventing recurrence.

Materials and Methods:

We performed a retrospective chart review including keloids which were treated by surgical excision followed by adjuvant radiotherapy by two surgeons from July 2019 to July 2020 in a single medical center. The keloids were treated with excision, tension-reduction suture and post-operative radiotherapy. A minimal margin of normal skin together with the connective tissue below the keloids were resected completely, undermining below the deep fascia and then suturing the deep fascia. Thereafter, the connective tissue and superficial fascia were sutured layer by layer. This suturing protocol smoothly approximate the wound edge from the deep fascia to superficial fascia and let dermis and epidermis sutures to be without tension. The adjuvant radiotherapy would be performed within 24 hours after operation. The radiotherapy protocol was based on the different body site. Silicone sheeting or silicone tape would be applied after sutural removal. The patients would return to clinic monthly for following up scar condition.

Results:

There were total twelve patients treated with our protocol. Eight patients were female and the average age was 40.8-year-old. Three keloids were located at ear helix, one at ear lobe, five at anterior chest, two at shoulder, one at back and two at pubic area. All patients had received previous treatments including operation, steroid injection and laser therapy. After our management, only one patient with keloid over left earlobe had recurrence and other patients had good scar quality without signs of recurrence until the last follow up.

Conclusion:

Our treatment protocol consists of surgical excision, adjuvant radiotherapy and post-operative wound care. We have found this combined approach could provide a pleasant result of scar and may reduce the recurrent rate.