Chondrocutaneous Bilateral Advancement Flap with Postoperative Radiation Therapy for a Helical Rim Keloid

Outcomes of omega variant keystone flap in conjunction with single fraction radiotherapy for helical keloids: A comprehensive one-year follow-up study

BACKGROUND

Achieving esthetically pleasing results for helical keloids can be challenging. This study aims to share the results of a treatment approach for helical keloids, which involves complete excision and reconstruction using an omega variant keystone flap, followed by a single fractional radiotherapy.

METHODS

The current study is a retrospective review of 25 helical keloids in 21 patients from May 2021 to March 2023. All keloid cases were excised entirely. We covered the defect with an omega variant keystone flap followed by a single fraction of 9.5 or 10 Gy radiotherapy within 24 h after surgery. The mean follow-up period was 12 months. The primary outcome was recorded as recurrence versus non-recurrence. The secondary outcome was scores assessed by the Patient and Observer Scar Assessment Scale.

RESULTS

All 25 keloids in 21 patients completed the treatment protocol, with a follow-up interval of 12 months. Of these patients, 100% had successful treatment of their keloids without any keloid recurrence. The postoperative course was uneventful except for one case of early postoperative flap congestion, which was spontaneously healed without any interventions. Scores obtained from the Patient and Observer Scar Assessment Scale showed that pain, itchiness, color, stiffness, thickness, irregularity, vascularity, pigmentation, thickness, relief, and pliability significantly improved. (p < 0.001).

CONCLUSIONS

We successfully reconstructed helical keloids using an omega variant keystone flap after keloid removal followed by 9.5 or 10 Gy single fractional radiotherapy without any keloid recurrence in one-year follow-ups.

Reconstruction of Full-Thickness Helical Defects Using a Superior Auricular Artery-Based Postauricular Chondrocutaneous Flap

BACKGROUND

The helix is the most common localization of auricular defects. Various techniques have been successfully used for the reconstruction of helical defects. However, redistributing the remaining auricular tissue to supply an ideal reconstruction base provides the best possible esthetic outcomes. The aim of this study is to present a new design for a postauricular chondrocutaneous flap to reconstruct the 3-dimensional curve and the folded structures in full-thickness helical defects.

METHODS

Nineteen patients with full-thickness helical defects were treated with the superior pedicle chondrocutaneous flap based on the superior auricular artery. The flap was designed on the postauricular area and comprised 3 sections, namely, deepithelialized, chondrocutaneous, and cutaneous sections (proximal to distal). Levels of patient's satisfaction on the final shape and auricular symmetry, and tissue compatibility between the flap and surrounding tissues were evaluated by the patients and objective observers.

RESULTS

The overall dimensions, projections, and curved structures of the defective helix maintained a smooth and contiguous appearance without asymmetry, notching, or trap-door deformities. The color, texture, and thickness of the flaps matched well with the adjacent auricles, and there was a moderate positive correlation between patient (9.47 ± 0.51) and observer (8.68 ± 0.63) correlation scores (r = 0.7485). The vast majority of the patients were very satisfied with the surgical outcome, and there was a statistically significant improvement in patient satisfaction (mean preoperative score, 1.26 ± 0.45; mean 12-month score, 4.79 ± 0.42; P < 0.00001).

CONCLUSIONS

Reconstruction of full-thickness helical defects requires "like tissue" characteristics and 3-dimensional cartilage support to avoid depression and notch deformities. The postauricular chondrocutaneous flap based on the superior auricular artery was shown to preserve the helical curve and folded sulcus, retain the size and subunits of the auricle, and ensure a color, texture, and thickness match between the flap and the adjacent tissues.

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

Surgical management of helical and retroauricular keloids has been rarely discussed. This study aims to introduce our successful reconstruction of helical and retroauricular keloids using a novel hemi-keystone flap. The current study is a retrospective review of patients with pathologically confirmed helical and retroauricular keloids. All keloid cases were completely excised. We covered the defect with a hemi-keystone flap followed by a single fraction of 10 Gy radiation therapy at postoperative day 0 or postoperative pressure therapy using magnets for four months. Treatment outcome was recorded as recurrence or nonrecurrence. A follow-up period of a minimum of 12 months was required in all patients. Of 45 keloids in 33 patients, none of the cases had a recurrence of their auricular keloids and the postoperative course was uneventful. We successfully reconstructed helical and retroauricular keloids using our modified hemi-keystone flaps without any keloid recurrence in one-year follow-ups. This is especially useful during the COVID-19 pandemic when facial mask wearing is mandatory. LEVEL OF EVIDENCE IV: 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 .

Long-term outcomes and recurrence-free interval after the treatment of keloids with a standardized protocol

BACKGROUND

Recurrence rates of keloids have generally been reported at one time point. However, the longer the duration after treatment, the greater the likelihood that such lesions will recur. In this study, we analysed the time to recurrence during long-term follow-up.

MATERIAL AND METHODS

We retrospectively reviewed recurrence-free interval in 52 patients with keloid (age 8-79 years) who had been treated between June 2006 and January 2011 using a standardised protocol developed by our group.

RESULTS

Mean duration of follow-up was 37.5 (range, 7-120) months in patients with keloid. Kaplan-Meier survival curves revealed a statistically significant difference in recurrence-free interval between ear keloids and keloids excluding ear keloids. Recurrence rate for keloids was high in the first 2 years after treatment.

CONCLUSIONS

Kaplan-Meier analysis was useful for understanding the tendency of recurrence of keloids after treatment using a standardised protocol.