Decreasing Recurrence after Keloid Excision with Sequential Triamcinolone Injections
Nicholas M. Kunda, MD, Rachel Ruotolo, MD, Tori Salorenzo, MS.
Long Island Plastic Surgical Group, Garden City, NY, USA.
BACKGROUND: Despite numerous studies proposing therapeutic targets for abnormal scarring, keloids remain notoriously difficult to treat. This study examines an easily reproducible technique using surgical excision and sequential triamcinolone acetonide injections in the treatment of keloids of various sizes and locations. When used in combination with a strict postoperative follow-up schedule, this protocol provides surgeons a safe and effective treatment regimen that can be easily incorporated into one’s surgical armamentarium.
METHODS: Following administration of general and/or local anesthetic, an elliptical incision was made around the base of the keloid under loupe magnification. Circumferential dissection was performed until normal tissue was encountered. The overlying skin was undermined as needed to provide a tension-free closure. The wound was then irrigated and meticulous hemostasis was obtained prior to primary closure in layers. Between 10-40 mg of triamcinolone acetonide was injected intraoperatively followed by application of bacitracin. Patients were evaluated 7-14 days postoperatively and instructed to begin scar massage with BioCorneum applications once sutures dissolved or were removed. Patients were re-evaluated every 6-8 weeks for repeat triamcinolone injections as indicated by their clinical course.
RESULTS: A total of 30 patients were evaluated. 56.7% were African American, 22.6% Hispanic, and 16.6% Caucasian, with 80% female and 20% male. 80% of keloids included in the study were located on the ear, 13.3% facial or submandibular, and 6.6% trunk. The average patient age was 18 years old. Piercings were the cause in 73.3% of cases, previous surgeries 10%, burns 3.3% and acne 3.3%. 60% of patients had not undergone any previous treatment, 20% underwent previous injection, 6.6% underwent previous excision, 10% underwent previous excision and injection, and 3.3% laser therapy. The average number of follow-up visits was 2.9 and the average number of follow-up triamcinolone injections were 1.8. There were no postoperative complications. Our overall recurrence rate was 23%.CONCLUSIONS:This study illustrates a technique for treating keloids that is safe, effective, and easily reproducible by a wide range of surgical subspecialists. Many patients, especially those within the pediatric population, may be averse to receiving a chemotherapeutic agent or radiation therapy as part of their treatment regimen. Furthermore, chemotherapeutic agents and radiation therapy at smaller hospitals and in office settings may be difficult to obtain. Using meticulous surgical technique, readily available corticosteroid injections, and close follow-up, we found an overall recurrence rate of 23% which is superior to the rates reported using other treatment modalities.
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