Individualized Surgery Combined with Radiotherapy and Triamcinolone Acetonide Injection for the treatment of Auricular Keloids

Abstract

Background: Although multiple methods have been proposed to treat auricular keloids, low curative effects and high recurrence rates are currently major clinical problems. Thereinto, surgery combined with radiotherapy and triamcinolone acetonide injection is considered to be the proper choice for comprehensive treatment of auricular keloids.Objective: This study aimed to evaluate the therapeutic effect of individualized surgery combined with radiotherapy for the treatment of auricular keloids. Methods: From February 2014 to February 2017, a total of 67 patients with 113 auricular keloids were enrolled in this study. According to the specific conditions of the lesions, the local tissue and the patient's wishes, different surgical methods were selected for scar excision and repair of the defect. Within 24 hours after the keloid was excised, 5 Mev electron beam irradiation by the linear accelerator was used for radiotherapy with a total dose of 20 Gy at interval of 1 day for 10 consecutive times. Triamcinolone acetonide was injected immediately after 1, 2, and 3 months after surgery.Results: A total of 113 keloids were received treatment. The follow-up period was 24 months. Fourteen keloids (12.39%) showed subjective recurrence with a success rate of 87.61%. The VSS scores were as follows: 82 keloids (72.57%) scored less than 5 points (good result), 21 keloids (18.58%) scored 6 to 10 points (fair result), and only 10 keloids (8.85%) scored more than 10 points (bad result). The effective rate was 91.15%.Conclusions: Individualized surgery combined with early postoperative radiotherapy and triamcinolone acetonide injection is an ideal treatment method to ensure good auricular appearance, low incidences of complications and recurrence based on effective treatment of auricular keloids.

Optimizing surgical outcome of auricular keloid with a novel multimodal approach

“…In our study, there were no radiation-related complications, especially radiation-induced hyperpigmentation, which may be partly attributed to additional intraoperative corticosteroid injection, effective in treating radiation dermatitis 30 . Another similar study utilizing individualized surgery (simple excision, core excision with scar flap reconstruction, and complete keloid excision with adjacent flap plasty) following immediate corticosteroid injection and radiotherapy to treat auricular keloids showed a recurrence rate of 12.39% 31 . Although a high total irradiation dose (20 Gy) and additional three postoperative monthly injections were applied, the recurrence rate was not superior to our results.…”