Surgical approach in the management of ear keloids: our experience with 30 patients

Abstract

Background Ear keloids are benign, fibrous proliferations due to excessive collagen synthesis and deposition. It is a popular practice to pierce earlobes for decorative earrings and adornment; this might trigger the keloid process. Although there are varied treatment modalities, it is unsatisfactory and has always been a challenge. The aim is to evaluate the efficacy of surgical treatment with intralesional therapy in auricular keloids. Methods We included 30 patients with 45 keloids over the ear. Patients were evaluated (including detailed history, complete physical and local examination), and photographs and written informed consent were taken. They were treated with: excision and closure, intralesional and/or surface cryotherapy, ablative laser, intralesional steroids, and 5‐fluorouracil. Excision and closure, and intralesional cryotherapy were done under local anesthesia. Closure was done after intramarginal excision with or without raising auto flaps, followed by intraoperative intralesional steroids to margins. Recurrence was assessed at 3 weeks, 3 months, 6 months, and 1 year. Results The age group of patients ranged from 14 to 57 years. A total of 32 out of 45 (71.1%) keloids were excised and were combined with intraoperative and postoperative intralesional steroid injection, with sessions depending on the patient's response. Eight (17.7%) and five (11.1%) keloids were treated using intralesional cryotherapy and only intralesional steroids, respectively. A total of 16.6% of patients had recurrence with one patient having recurrence of bilateral earlobes keloid. Conclusion Keloidectomy with intraoperative and postoperative intralesional steroid injections has been very effective in the treatment of ear keloids. Different treatment modalities act synergistically, but excision surgery gives good results as it aims at maintaining ear architecture.

Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids

“…After excluding statistical outliers by assessing studentized residuals, a total of 22 studies were included in the meta-analysis, totaling 608 keloids. 8,14–34 (In cases where one patient had multiple keloids treated, each keloid was considered a unique case.) Additional therapies used are summarized in Table 1.…”

Surgery and superficial x‐ray radiotherapy for keloids of the preauricular and contralateral ear lobe: Case report

“…This approach maximized aesthetic enhancement in the retroauricular region due to the similarity in skin texture and minimal color discrepancy. Recent advancements in plastic surgery techniques have introduced various flap methods for earlobe reconstruction, including utilizing the side of the earlobe for rotational flaps, 6 rectangular propulsive flaps, 7 folding of the posterior ear flap, 8 wedging excision and suturing 9 and the V–Y propulsive flap 10 . Each of these techniques strives to achieve the most optimal appearance of the earlobe.…”

Surgical Approach for Auricular Keloid: Wedge Resection Technique

“…Our protocol involving the wedge resection technique and intralesional steroid injections has shown successful outcomes with a low complication rate, low recurrence rate, and favorable cosmetic results during follow-up of up to 3 years. 5 The authors are planning for a future formal expanded study.…”