Aesthetic Reconstruction of Auricular Keloids with a Novel Hemi-keystone Flap

Park, Tae Hwan

doi:10.1007/s00266-022-02909-4

Cited by 8 publications

(7 citation statements)

References 16 publications

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“…9 The fact that keloid-extirpation surgery must be followed by postoperative radiotherapy shapes surgical decision-making: it is preferable to close keloid-resection sites primarily (but without tension) because irradiation can prevent the uptake of the skin grafts or local flaps that are needed for tensionlessly covering larger defects. 10 Consequently, in our case, we used the total-excision method to remove the keloid mass.…”

Section: Discussionmentioning

confidence: 99%

Ear Keloid as an Unusual Complication of Prolonged Mask Use during the COVID-19 Pandemic

Lumintang,

Dohi,

Ogawa

2024

Plastic and Reconstructive Surgery - Global Open

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Summary: The recent COVID-19 pandemic required many people to wear ear-loop face masks (ELFMs) for protracted periods, and ear injuries have been reported. Here, we report a rare case of a keloid on the right posterior ear that appeared to arise from prolonged ELFM use. A 76-year-old Japanese man presented with a 7.3 × 2.2 × 1.4-cm keloid running from the medial retroauricular sulcus to the posterior lobule. The lack of keloid history suggested the absence of genetic risk factors. The patient reported extensive mask-wearing habits that were augmented by the pandemic. The keloid developed from an ear injury. Although it healed well, it started thickening 2 months later. Because local mechanical forces (eg, pressure/friction) can promote keloid growth, the ELFM may have provoked the keloid. The patient disclosed a history of uncontrolled hypertension and diabetes mellitus, which associate with severe keloids. The whole keloid was removed via total excision, and the defect was closed primarily and subjected to 15Gy/2Fr radiotherapy. The patient was advised to use a different mask type. Twelve months later, the scar had healed without complications or recurrence and with good cosmetic outcomes. Thus, ELFMs can promote retroauricular keloid formation, possibly by imposing local pressure/friction. ELFMs may also raise local skin temperatures and humidity, thereby fostering infection, which can trigger keloids. Hypertension/diabetes may further elevate the risk of EFLM-induced keloid. Thus, an auricular keloid is an unusual complication of prolonged ELFM use. Combination therapy can have excellent outcomes. Patients with keloid risk factors should be advised to use face masks without ear loops.

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Section: Discussionmentioning

confidence: 99%

Ear Keloid as an Unusual Complication of Prolonged Mask Use during the COVID-19 Pandemic

Lumintang,

Dohi,

Ogawa

2024

Plastic and Reconstructive Surgery - Global Open

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“…Furthermore, we performed a rotation Hemi-keystone flap to repair a nasal tip defect in case #3. 11,12 . This modification involves incising the V portion of the keystone flap design at one side and extending it to one-half of the greater curvature.…”

Section: Discussionmentioning

confidence: 99%

“…Furthermore, we performed a rotation Hemi-keystone flap to repair a nasal tip defect in case #3 11,12 …”

Section: Discussionmentioning

confidence: 99%

“…Following tumor resection with a safety margin, a rotation Hemi-keystone keystone flap was designed on one side of the defect as previously described. 11,12 An incision is made along the marked flap, and the curvilinear portion of the flap is then undermined, rotated, and closed the defect tension-free. The representative case is shown in Figure 4.…”

Section: Case 3 (Rotation Hemi-keystone Flap)mentioning

confidence: 99%

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The Versatility of Keystone Flaps for Skin Cancer Reconstruction of the Nose

Hifny,

Park

2023

Journal of Craniofacial Surgery

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Nasal reconstruction has been a challenging problem for even the most experienced surgeon to provide excellent esthetic and functional outcomes. Although the bilobed flap offers distinct advantages for reconstructing these defects using an adjacent tissue with similar esthetic qualities, this flap has several potential limitations. The authors hypothesized that the conventional keystone flap and its variants provide a versatile and easily reproducible reconstructive option for nasal reconstruction after wide skin cancer excision. The authors retrospectively reviewed 12 consecutive soft tissue reconstruction data using 3 types of keystone flaps between May 2021 and July 2023. The authors reviewed all patients who underwent reconstruction with the keystone flap or its modification to repair cutaneous nasal defects following wide skin cancer excision. The authors reconstructed small- to medium-sized nasal defects ranging from 1×1 to 2.5×2.5 cm2 with a mean size of 1.2×1.1 cm2 using either a conventional keystone flap or its modification, including the Omega variant and rotation Hemi-keystone flap. All patients were satisfied with the esthetic outcomes. Keystone flaps are a versatile option for reconstructing the nose after cancer surgery. This strategy obviates the need for a bilobed flap after cancer removal in the nose.

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“…Flap reconstruction after complete keloid excision can be another option in this scenario. [17][18][19] Nevertheless, it has disadvantages such as keloid recurrence in the flap donor site, partial flap loss, and flap failure leading to additional reconstructive surgery. Also, there is an inherent risk of keloid aggravation with a relatively invasive approach of complete excision compared with intralesional excision.…”

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confidence: 99%

A Triple Combination Therapy Using 2-mm Biopsy Punch for the Treatment of Multifocal Keloids

Park

2023

Dermatol Surg

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BACKGROUND Keloid treatment is challenging. The surgical approach can be divided into complete excision versus partial excision. OBJECTIVE The current study aims to introduce our novel surgical approach of partial excision using a 2-mm punch biopsy device to treat refractory multifocal keloids in the trunk. MATERIALS AND METHODS This is a case series of 30 patients with refractory multifocal keloids treated with a triple combination therapy consisting of a punch-assisted partial excision and intralesional triamcinolone injections followed by immediate single fractional electron beam radiotherapy within 8 hours, postoperatively. The follow-up period was 12 months. The primary outcome was recorded as recurrence versus nonrecurrence or aggravation versus remission. The secondary outcome was patient satisfaction as assessed by the POSAS. RESULTS The recurrence or aggravation of keloid was not found without complications. Scores obtained from the POSAS patient scale showed that pain, itchiness, color, stiffness, thickness, and irregularity significantly improved. CONCLUSION Our novel surgical approach using a 2-mm punch biopsy device effectively treats refractory multifocal keloids once considered intractable. Triple combination therapy of partial excision using a 2-mm punch biopsy device, intralesional triamcinolone injections, followed by immediate single fractional electron beam radiotherapy, is a safe, efficacious, and more convenient protocol to treat this condition.

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Aesthetic Reconstruction of Auricular Keloids with a Novel Hemi-keystone Flap

Cited by 8 publications

References 16 publications

Ear Keloid as an Unusual Complication of Prolonged Mask Use during the COVID-19 Pandemic

Ear Keloid as an Unusual Complication of Prolonged Mask Use during the COVID-19 Pandemic

The Versatility of Keystone Flaps for Skin Cancer Reconstruction of the Nose

A Triple Combination Therapy Using 2-mm Biopsy Punch for the Treatment of Multifocal Keloids

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