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Dong W, Xiao X, Yang X, Zhao Z. Efficacy and safety of surgical excision and reconstruction combined with radiotherapy for huge keloids: A 13-year experience. J Cosmet Dermatol 2024; 23:970-977. [PMID: 37947204 DOI: 10.1111/jocd.16060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 10/06/2023] [Accepted: 10/24/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Surgical excision combined with radiotherapy is considered an effective treatment for keloids, while the efficacy and safety of this regimen for huge keloids in patients who need reconstruction after excision is still unclear. Therefore, this study aimed to evaluate the efficacy and safety of surgical excision and reconstruction combined with radiotherapy for huge keloids in a single center with 13 years of experience. METHODS All consecutive patients with huge keloids who underwent surgical excision and reconstruction combined with radiotherapy were identified. Demographic information, prior interventions for keloids, parameters and complications, and recurrence rates were documented. RESULTS Twenty-one patients (10 males; mean age, 43.19 ± 18.15 years) were included, 14 patients reconstructed with z-plasties, 5 with skin grafts, and 2 with skin flaps. During a mean follow-up of 75 months, one patient developed local necrosis without the need for revision surgery and two patients developed temporary hyperpigmentation. Two patients with the z-plasties suffered partial keloids recurrence, which was healed with corticosteroid injection. No wound infection, hematoma, telangiectasia, or new keloids at donor sites were observed. The overall appearance of reconstructed defects was aesthetically acceptable. CONCLUSION Surgical excision and reconstruction combined with radiotherapy may be safe and effective for huge keloids.
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Affiliation(s)
- Wenfang Dong
- Department of Plastic and Reconstructive Surgery, Peking University Third Hospital, Beijing, China
| | - Xiaodi Xiao
- Department of Plastic and Reconstructive Surgery, Peking University Third Hospital, Beijing, China
| | - Xin Yang
- Department of Plastic and Reconstructive Surgery, Peking University Third Hospital, Beijing, China
| | - Zhenmin Zhao
- Department of Plastic and Reconstructive Surgery, Peking University Third Hospital, Beijing, China
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Ogawa R. The Most Current Algorithms for the Treatment and Prevention of Hypertrophic Scars and Keloids: A 2020 Update of the Algorithms Published 10 Years Ago. Plast Reconstr Surg 2022; 149:79e-94e. [PMID: 34813576 PMCID: PMC8687618 DOI: 10.1097/prs.0000000000008667] [Citation(s) in RCA: 113] [Impact Index Per Article: 56.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 05/12/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND In 2010, this Journal published my comprehensive review of the literature on hypertrophic scars and keloids. In that article, I presented evidence-based algorithms for the prevention and treatment of these refractory pathologic scars. In the ensuing decade, substantial progress has been made in the field, including many new randomized controlled trials. To reflect this, I have updated my review. METHODS All studies were evaluated for methodologic quality. Baseline characteristics of patients were extracted along with the interventions and their outcomes. Systematic reviews, meta-analyses, and comprehensive reviews were included if available. RESULTS Risk factors that promote hypertrophic scar and keloid growth include local factors (tension on the wound/scar), systemic factors (e.g., hypertension), genetic factors (e.g., single-nucleotide polymorphisms), and lifestyle factors. Treatment of hypertrophic scars depends on scar contracture severity: if severe, surgery is the first choice. If not, conservative therapies are indicated. Keloid treatment depends on whether they are small and single or large and multiple. Small and single keloids can be treated radically by surgery with adjuvant therapy (e.g., radiotherapy) or multimodal conservative therapy. For large and multiple keloids, volume- and number-reducing surgery is a choice. Regardless of the treatment(s), patients should be followed up over the long term. Conservative therapies, including gel sheets, tape fixation, topical and injected external agents, oral agents, and makeup therapy, should be administered on a case-by-case basis. CONCLUSIONS Randomized controlled trials on pathologic scar management have increased markedly over the past decade. Although these studies suffer from various limitations, they have greatly improved hypertrophic scar and keloid management. Future high-quality trials are likely to improve the current hypertrophic scar and keloid treatment algorithms further.
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Affiliation(s)
- Rei Ogawa
- From the Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School
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Miles OJ, Zhou J, Paleri S, Fua T, Ramakrishnan A. Chest keloids: effect of surgical excision and adjuvant radiotherapy on recurrence, a systematic review and meta-analysis. ANZ J Surg 2021; 91:1104-1109. [PMID: 33438368 DOI: 10.1111/ans.16561] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 12/07/2020] [Accepted: 12/15/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Chest keloids are a difficult sub-group of scars to treat, likely secondary to the high wound tension in the area that promotes excessive fibroblast proliferation and collagen deposition. Excision and adjuvant radiotherapy has been demonstrated as an efficacious treatment for keloids in general, but no meta-analysis exists to support the claims for chest keloids. This study aims to identify the rate of recurrence after surgical resection and radiotherapy on patients with chest keloids. METHODS A search was performed using Embase, MEDLINE, Pubmed and Cochrane database on 22 December 2018 for terms 'radiotherapy', 'keloid' and 'chest'. Papers included met a prospectively designed inclusion criteria assessed by multiple investigators. RESULTS Twelve studies, including 1 randomized controlled trial, were included for a total of 400 patients with a chest keloid scar managed with surgical excision and adjuvant radiotherapy. Overall pooled-estimate of recurrence rate was 22% (95% CI 12-32%). Meta-regression did not demonstrate a significant effect for method of wound closure, type of radiotherapy, radiotherapy dose (BED10 ) and study type. CONCLUSION Excision and adjuvant radiotherapy represents an effective method of treatment for chest keloids, however sufficient prospective data, including randomized controlled trials, did not yet exist to support these findings. Further studies with sufficient sub-group analysis for keloid location are required to add to the pool of literature that can be added to this meta-analysis.
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Affiliation(s)
- Oliver J Miles
- Department of Plastic and Reconstructive Surgery, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Jieyun Zhou
- Department of Plastic and Reconstructive Surgery, The Alfred Hospital Melbourne, Melbourne, Victoria, Australia
| | - Sarang Paleri
- Department of Cardiology, St Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia
| | - Tsien Fua
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Anand Ramakrishnan
- Department of Plastic and Reconstructive Surgery, Royal Melbourne Hospital, Melbourne, Victoria, Australia
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Ogawa R. Propeller Flaps for the Anterior Trunk. Semin Plast Surg 2020; 34:171-175. [PMID: 33041687 PMCID: PMC7542203 DOI: 10.1055/s-0040-1714270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Various types of propeller flaps from multiple donor sites can be used to reconstruct anterior trunk skin defects. The actual selection depends on the condition and location of the recipient site, especially if it is to be the chest or abdomen that requires attention. Before surgery commences, it is always important to use an imaging analyses such as computed tomography angiography to examine and identify perforators that could perfuse a perforator-pedicled propeller flap (PPPF), as it is the most multifaceted imaging technique. Clusters of perforators that can be commonly used for the "workhorse" PPPFs for the thoracic and abdominal regions are the internal mammary artery perforator, the musculophrenic artery perforator, and the deep inferior epigastric perforator. These perforators are reliable and large enough to support long and large propeller flaps that will cover most defects in this region, while still allowing primary donor-site closure.
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Affiliation(s)
- Rei Ogawa
- Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, Tokyo, Japan
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Ogawa R, Akita S, Akaishi S, Aramaki-Hattori N, Dohi T, Hayashi T, Kishi K, Kono T, Matsumura H, Muneuchi G, Murao N, Nagao M, Okabe K, Shimizu F, Tosa M, Tosa Y, Yamawaki S, Ansai S, Inazu N, Kamo T, Kazki R, Kuribayashi S. Diagnosis and Treatment of Keloids and Hypertrophic Scars-Japan Scar Workshop Consensus Document 2018. BURNS & TRAUMA 2019; 7:39. [PMID: 31890718 PMCID: PMC6933735 DOI: 10.1186/s41038-019-0175-y] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/23/2019] [Accepted: 10/14/2019] [Indexed: 01/05/2023]
Abstract
There has been a long-standing need for guidelines on the diagnosis and treatment of keloids and hypertrophic scars that are based on an understanding of the pathomechanisms that underlie these skin fibrotic diseases. This is particularly true for clinicians who deal with Asian and African patients because these ethnicities are highly prone to these diseases. By contrast, Caucasians are less likely to develop keloids and hypertrophic scars, and if they do, the scars tend not to be severe. This ethnic disparity also means that countries vary in terms of their differential diagnostic algorithms. The lack of clear treatment guidelines also means that primary care physicians are currently applying a hotchpotch of treatments, with uneven outcomes. To overcome these issues, the Japan Scar Workshop (JSW) has created a tool that allows clinicians to objectively diagnose and distinguish between keloids, hypertrophic scars, and mature scars. This tool is called the JSW Scar Scale (JSS) and it involves scoring the risk factors of the individual patients and the affected areas. The tool is simple and easy to use. As a result, even physicians who are not accustomed to keloids and hypertrophic scars can easily diagnose them and judge their severity. The JSW has also established a committee that, in cooperation with outside experts in various fields, has prepared a Consensus Document on keloid and hypertrophic scar treatment guidelines. These guidelines are simple and will allow even inexperienced clinicians to choose the most appropriate treatment strategy. The Consensus Document is provided in this article. It describes (1) the diagnostic algorithm for pathological scars and how to differentiate them from clinically similar benign and malignant tumors, (2) the general treatment algorithms for keloids and hypertrophic scars at different medical facilities, (3) the rationale behind each treatment for keloids and hypertrophic scars, and (4) the body site-specific treatment protocols for these scars. We believe that this Consensus Document will be helpful for physicians from all over the world who treat keloids and hypertrophic scars.
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Affiliation(s)
- Rei Ogawa
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Sadanori Akita
- 2Department of Plastic Surgery, Wound Repair and Regeneration, Fukuoka University, Fukuoka, 814-0180 Japan
| | - Satoshi Akaishi
- 3Department of Plastic Surgery, Nippon Medical School Musashikosugi Hospital, 1-396 Kosugicho, Nakahara-ku, Kawasaki-shi, Kanagawa 211-8533 Japan
| | - Noriko Aramaki-Hattori
- 4Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Teruyuki Dohi
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Toshihiko Hayashi
- 5Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Kazuo Kishi
- 4Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Taro Kono
- 6Department of Plastic Surgery, Tokai University School of Medicine, 4-1-1 Kitakaname, Hiratsuka, Kanagawa 259-1292 Japan
| | - Hajime Matsumura
- 7Department of Plastic and Reconstructive Surgery, Tokyo Medical University, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo, 160-0023 Japan
| | - Gan Muneuchi
- 8Department of Plastic and Reconstructive Surgery, Osaka Saiseikai Nakatsu Hospital, 2-10-39 Shibata, Kita-ku, Osaka, 530-0012 Japan
| | - Naoki Murao
- 5Department of Plastic and Reconstructive Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Kita-15, Nishi-7, Kita-ku, Sapporo, 060-8638 Japan
| | - Munetomo Nagao
- 9Department of Plastic, Reconstructive and Aesthetic Surgery, Iwate Medical University School of Medicine, 19-1 Uchimaru, Morioka, Iwate 020-8505 Japan
| | - Keisuke Okabe
- 4Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo, 160-8582 Japan
| | - Fumiaki Shimizu
- 10Department of Plastic Surgery, Oita University Hospital, 1-1 Idaigaoka, Hasamamachi, Yufu-shi, Oita 879-5503 Japan
| | - Mamiko Tosa
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Yasuyoshi Tosa
- 11Department of Plastic Surgery, Showa University Fujigaoka Hospital, 1-30 Fujigaoka, Aoba-ku, Yokohama, Kanagawa Japan
| | - Satoko Yamawaki
- Department of Plastic and Reconstructive Surgery, Japanese Red Cross Fukui Hospital, 2-4-1 Tsukimi, Fukui, 918-8501 Japan
| | - Shinichi Ansai
- 13Division of Dermatology and Dermatopathology, Nippon Medical School Musashikosugi Hospital, 1-396, Kosugicho, Nakahara-ku, Kawasaki-shi, Kanagawa 211-8533 Japan
| | - Norihisa Inazu
- 14Faculty of Pharmaceutical Sciences, Teikyo Heisei University, 4-21-2 Nakano, Nakano-ku, Tokyo, 164-8530 Japan
| | - Toshiko Kamo
- Wakamatsu-cho Mental and Skin Clinic, 9-4 Wakamatsu-cho, Shinjyuku-ku, Tokyo, 162-0056 Japan
| | - Reiko Kazki
- 1Department of Plastic, Reconstructive and Aesthetic Surgery, Nippon Medical School, 1-1-5 Sendagi Bunkyo-ku, Tokyo, 113-8603 Japan
| | - Shigehiko Kuribayashi
- 16Department of Radiation Oncology, Nippon Medical School Hospital, Tokyo, 113-8603 Japan
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Liu Y, Xiao H, Liu X, Cao C, Wu J, Yao B, Chen Y, Xu X. [Effectiveness of internal mammary artery perforator propeller flap repair combined with radiotherapy for chest keloid in female patients]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2018; 32:1196-1200. [PMID: 30129345 DOI: 10.7507/1002-1892.201803004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To investigate the effectiveness of internal mammary artery perforator (IMAP) propeller flap repair combined with radiotherapy for chest keloid in female patients. Methods Between January 2015 and December 2016, 15 female patients with chest keloids were treated, aged 28-75 years (mean, 45.2 years). The keloid disease duration was 1-28 years (median, 6 years). The causes of disease included secondary keloid caused by folliculitis in 7 cases, cardiac surgery in 4 cases, skin abrasion in 2 cases, mosquito bite in 1 case, and unknown etiology in 1 case. The size of keloid ranged from 5 cm×3 cm to 17 cm×6 cm. The IMAP propeller flaps were used to repair the defects after chest keloid excision. The size of flaps ranged from 7 cm×5 cm to 14 cm×8 cm. The donor sits were sutured directly. The routine radiotherapy was performed after operation. Results All IMAP propeller flaps survived well, and the donor site healed by first intention. All 15 patients were followed up 12-24 months (mean, 16 months). No telangiectasia or incision dehiscence occurred. No radiation-related carcinogenesis occurred during follow-up. The patients were satisfied with the breast shape and symmetry after operation. The symptoms of pain and itching were relieved at keloid area in 13 cases (86.7%), with no obvious recurrence of keloid at the donor site and the primary site. Only 2 cases (13.3%) recurred and were treated with continuously conservative treatment. Conclusion IMAP propeller flap is an ideal reconstruction method for repairing the wounds after chest keloid excision in female patients, which can preserve the good breast shape. The IMAP propeller flap repair combined with early postoperative radiotherapy can effectively reduce the recurrence rate, and the effectiveness is satisfactory.
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Affiliation(s)
- Yong Liu
- Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Haitao Xiao
- Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xiaoxue Liu
- Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Chang Cao
- Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Junliang Wu
- Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Bing Yao
- Department of Radiation Oncology, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yuan Chen
- West China School of Stomatology, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Xuewen Xu
- Department of Plastic Surgery, West China Hospital, Sichuan University, Chengdu Sichuan, 610041,
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Park TH, Lee JW, Kim CW. The fortune cookie flap for aesthetic reconstruction after chest keloid resection: a small case series. J Cardiothorac Surg 2018; 13:31. [PMID: 29673376 PMCID: PMC5907744 DOI: 10.1186/s13019-018-0713-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 04/04/2018] [Indexed: 11/23/2022] Open
Abstract
Background Generally, the recurrence rate of keloids is unacceptably high after surgical excision alone. Nevertheless, surgical reduction of keloids is inevitable in many cases. The reconstruction of extensive soft tissue defects following complete keloid resection is challenging to surgeons. In this study, we present our clinical experience using a novel fortune cookie flap for treating chest keloids. This flap provides an excellent surgical option that maintains natural appearance with minimal donor-site morbidity. Methods We retrospectively reviewed the data from 3 consecutive cases of reconstruction using the fortune cookie flap following resection of chest keloids between March and December, 2017. Results Successful reconstructions were performed without any major complications. The mean dimensions of the reconstructed defect were 5.0 × 4.2 cm, while the mean dimensions of the flap were 7.7 × 5.7 cm. Conclusions Owing to its simplicity, reliability, versatility, minimal morbidity and excellent aesthetics, the fortune cookie flap is as an excellent option for reconstruction following complete keloid resection on the chest. Electronic supplementary material The online version of this article (10.1186/s13019-018-0713-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Tae Hwan Park
- Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi, 13496, Republic of Korea.
| | - Jang Won Lee
- Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi, 13496, Republic of Korea
| | - Chan Woo Kim
- Department of Plastic and Reconstructive Surgery, CHA Bundang Medical Center, CHA University, 59 Yatap-ro, Bundang-gu, Seongnam, Gyeonggi, 13496, Republic of Korea
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Gokalp H. Evaluation of nonablative fractional laser treatment in scar reduction. Lasers Med Sci 2017; 32:1629-1635. [DOI: 10.1007/s10103-017-2303-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Accepted: 08/06/2017] [Indexed: 10/19/2022]
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