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.

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This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

Dead space and poor drainage are the main reasons for intractable sacral decubitus ulcers. The objective of this study was to investigate the effects of treatment for sacral decubitus ulcer using space filling through muscle flap and closed irrigation. A total of 22 patients with serious sacral decubitus ulcer were treated with space filling through muscle flap and closed irrigation. After debridement of the decubitus ulcer, the infected areas over the bony prominence and osseous prominences were debrided. We elevated biceps femoris long head or semitendinosus and semimembranosus muscle. Pedicled by proximal part of muscle, the muscle flap was elevated to cover the ischial tuberosity. Transfusion systems of inflow and outflow drainage were placed between the muscle flap and ischial tuberosity. Wound healing and complications were observed. One wound dehiscence healed after secondary suturing. One wound gradually healed by dressing change after 3 weeks. The other cases had good results. Space filling and closed irrigation were complementary. The use of these two methods simultaneously is useful for the management of sacral decubitus ulcers.

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