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Zaccardelli A, Harb JL, Papathanasiou E, Scott AR. Presentation, Management, and Outcomes of Pathologic Scars Within a Pediatric Otolaryngology Practice. Laryngoscope 2024; 134:3127-3135. [PMID: 38308543 PMCID: PMC11182727 DOI: 10.1002/lary.31320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 11/08/2023] [Accepted: 01/17/2024] [Indexed: 02/04/2024]
Abstract
OBJECTIVES This study aims to review the spectrum of scarring that may present to an urban, pediatric otolaryngology practice and determine if associations exist between race, scar location, treatment modality, and outcomes following interventions for scarring. METHODS Retrospective cohort study among 115 pediatric patients with 138 unique keloids or hypertrophic scars (HTS), and 141 children presenting for tonsillectomy at Tufts Medical Center. Age at presentation and sex assigned at birth were collected for both populations. For those presenting for pathologic scars, income quintile, self-identified race/ethnicity, anatomical location, treatment number and type, and clinical outcome were also analyzed. Multivariate analyses calculated adjusted odds ratios (aORs) and 95% confidence intervals to assess associations between scar subsite, intervention type, and persistence after treatment. RESULTS Compared to individuals presenting for tonsillectomy, a disproportionate percentage of patients presenting for scarring identified as Black (26.6% vs. 13.5%) or Asian (17.4% vs. 7.1%, p = 0.016) or were male (61.7% vs. 49.7%, p = 0.053). Individuals identifying as Black or Asian were more likely to present with ear lobe and neck scars, respectively (50.0% vs. 45.5%, p = <0.001). Ear scars were significantly more likely to receive excision at initial treatment (aOR = 5.86 [1.43-23.96]) compared to other subsites, and were more likely to require >1 treatment (aOR = 5.91 [1.53-22.75]). CONCLUSION Among pediatric patients presenting with keloids or HTS, children who identified as Black or Asian were more likely to present with ear and neck scars, respectively. Ear scars were frequently treated with excision and appear more likely to require adjuvant treatments and multiple interventions. LEVEL OF EVIDENCE 3 Laryngoscope, 134:3127-3135, 2024.
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Affiliation(s)
- Alessandra Zaccardelli
- Department of Otolaryngology-Head and Neck, Tufts University School of Medicine, Boston, Massachusetts, U.S.A
| | - Jennifer L Harb
- Division of Pediatric Otolaryngology and Facial Plastic and Reconstructive Surgery, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
| | - Evangelos Papathanasiou
- Department of Periodontology, Tufts University School of Dental Medicine, Boston, Massachusetts, U.S.A
| | - Andrew R Scott
- Department of Otolaryngology-Head and Neck, Tufts University School of Medicine, Boston, Massachusetts, U.S.A
- Division of Pediatric Otolaryngology and Facial Plastic and Reconstructive Surgery, Boston, Massachusetts, U.S.A
- Department of Otolaryngology-Head and Neck Surgery, Tufts Medical Center, Boston, Massachusetts, U.S.A
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Kwon SH, Lee J, Yoo J, Jung Y. Artificial keloid skin models: understanding the pathophysiological mechanisms and application in therapeutic studies. Biomater Sci 2024; 12:3321-3334. [PMID: 38812375 DOI: 10.1039/d4bm00005f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
Keloid is a type of scar formed by the overexpression of extracellular matrix substances from fibroblasts following inflammation after trauma. The existing keloid treatment methods include drug injection, surgical intervention, light exposure, cryotherapy, etc. However, these methods have limitations such as recurrence, low treatment efficacy, and side effects. Consequently, studies are being conducted on the treatment of keloids from the perspective of inflammatory mechanisms. In this study, keloid models are created to understand inflammatory mechanisms and explore treatment methods to address them. While previous studies have used animal models with gene mutations, chemical treatments, and keloid tissue transplantation, there are limitations in fully reproducing the characteristics of keloids unique to humans, and ethical issues related to animal welfare pose additional challenges. Consequently, studies are underway to create in vitro artificial skin models to simulate keloid disease and apply them to the development of treatments for skin diseases. In particular, herein, scaffold technologies that implement three-dimensional (3D) full-thickness keloid models are introduced to enhance mechanical properties as well as biological properties of tissues, such as cell proliferation, differentiation, and cellular interactions. It is anticipated that applying these technologies to the production of artificial skin for keloid simulation could contribute to the development of inflammatory keloid treatment techniques in the future.
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Affiliation(s)
- Soo Hyun Kwon
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
| | - Jongmin Lee
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
- KU-KIST Graduate School of Converging Science and Technology, Korea University, Republic of Korea
| | - Jin Yoo
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
| | - Youngmee Jung
- Center for Biomaterials, Korea Institute of Science and Technology, Seoul 02792, Republic of Korea.
- School of Electrical and Electronic Engineering, YU-KIST Institute, Yonsei University, Seoul 03722, Republic of Korea
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Tahir SM, Ihebom D, Simman R. Compression Therapy for Keloid Scars: A Systematic Review and Meta-analysis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5864. [PMID: 38841536 PMCID: PMC11150022 DOI: 10.1097/gox.0000000000005864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 04/08/2024] [Indexed: 06/07/2024]
Abstract
Background Keloid scars have a multitude of treatments with varying success rates. The purpose of this systematic review and meta-analysis is to study the different types of compression therapies used following surgical excision and their recurrence rates. Methods A literature search was conducted using the following databases: PubMed, Embase, and Cochrane Reviews. The following keywords were used in the search: "keloid" and "compression." The following inclusion criteria were used: (1) identifying lesion must be a keloid and (2) use of any type of compression therapy for keloid scar. Results A total of 27 articles were included in the final analysis, grouped into three treatment modalities for comparison. The three treatment modalities are (1) surgical excision and compression earring, (2) surgical excision and silicone gel sheeting, and (3) surgical excision, compression earring, and silicone gel sheeting. Based on our analysis, combination treatment with compression earring device and silicone gel sheeting had the lowest recurrence rate when compared with compression earring device or silicone gel alone, but the difference in recurrence rates between the three treatment modalities was not statistically significant. Conclusions There were too few studies included in each treatment modality with even fewer sample sizes, and there is a need for a greater number of studies with increased sample size to evaluate which therapy is the most efficacious in preventing keloid recurrence following surgical excision.
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Affiliation(s)
- Sadia M. Tahir
- From the College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio
| | - Diane Ihebom
- From the College of Medicine and Life Sciences, University of Toledo, Toledo, Ohio
| | - Richard Simman
- College of Medicine and Life Sciences, Department of Surgery, University of Toledo, Toledo, Ohio
- ProMedica Health Network, Wound Care Program, Jobst Vascular Institute, Toledo, Ohio
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Lawera NG, Madzia J, Casey LC, Guyton RL, Woodyard De Brito KC, Kinzer A, Ulma RM, Pan BS, Schwentker AR, Leto Barone AA. Keloid Intralesional Excision Reduces Recurrence: A Meta-analytic Study of the Available Literature on 608 Keloids. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5652. [PMID: 38463702 PMCID: PMC10923361 DOI: 10.1097/gox.0000000000005652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 01/16/2024] [Indexed: 03/12/2024]
Abstract
Background The objective of this meta-analysis was to examine the effectiveness of keloid intralesional excision (KILE) in preventing recurrence. Treatment of keloids using surgical excision alone leads to high rates of recurrence. To date, there are no widely accepted guidelines for keloid treatment, and a multitude of adjunctive therapies are used to reduce recurrence. Despite these efforts, recurrence remains high. In this study, we conducted a meta-analysis of the existing literature on KILE to determine its role in recurrence reduction. Methods A literature review using PubMed, Scopus, and Web of Science databases was performed. Two authors independently evaluated studies for eligibility. Incidence of keloid recurrence was recorded, and a comprehensive meta-analysis was performed to assess the pooled keloid recurrence rate, as well as the effect of additional therapies. Results Twenty-two studies evaluating intralesional excision of 608 keloids were included in the study. Average time to follow-up was 19.2 months (range 6-35 months). A meta-analysis of proportions was conducted, demonstrating a pooled recurrence rate of 13% (95% confidence interval, 9%-16%). There was no evidence that using therapies in addition to KILE had a significant effect on the overall pooled recurrence rate. Conclusions A meta-analysis of 608 keloids shows that KILE is an effective technique in preventing keloid recurrence, with a pooled recurrence rate of 13% compared with previously reported rates of 45%-100% after complete excision. Although there are no standard guidelines for keloid treatment, our meta-analysis shows that KILE is promising in recurrence reduction.
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Affiliation(s)
- Nathan G. Lawera
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Jules Madzia
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Liann C. Casey
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Rodney L. Guyton
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | | | - Alexandra Kinzer
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Raquel M. Ulma
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Brian S. Pan
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Ann R. Schwentker
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Angelo A. Leto Barone
- From Division of Pediatric Plastic Surgery, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
- Division of Plastic and Craniofacial Surgery, Nemours Children’s Hospital, Orlando, Fla
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Ahmednaji NM, Wu XY, Wang YX, Chen XD. Surgical Core Excision With Tongue Flap Closure in Combination With Electron Beam Radiotherapy in the Treatment of Ear Keloids. Dermatol Surg 2023; 49:S58-S63. [PMID: 37116002 DOI: 10.1097/dss.0000000000003778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/30/2023]
Abstract
BACKGROUND Ear keloids are disfiguring disorders resistant to various treatments. OBJECTIVE The authors aimed to assess the efficacy of surgical treatment of ear keloids in a Chinese population using a tongue flap with electron beam radiotherapy. METHODS The authors conducted a retrospective analysis of 41 patients treated at the Affiliated Hospital of Nantong University between January 2018 and May 2021. Core excision with a tongue flap was performed, followed by 3 days of electron beam radiotherapy and 3 to 6 months of pressure clip application. The Vancouver Scar Scale (VSS) and the Visual Analog Scale (VAS) were used to assess the results. RESULTS The mean age of the patients was 28.10 years (9-61 years). Postoperative follow-up ranged from 5 to 32 months (mean:12.07). The patients underwent 3 days of postoperative radiotherapy followed by pressure clips for 2 to 6 months. Thirty-seven patients had no recurrence, whereas 4 had a mild recurrence (<3 mm in height) with redness and itchiness. The VSS and VASscores significantly decreased. (p < .05). CONCLUSION Excision with a tongue flap and radiotherapy can be used as the primary treatment for ear keloids considering the good outcome and long-term management.
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Affiliation(s)
- Nebil Mahamoud Ahmednaji
- All authors are affiliated with the Department of Dermatology, Affiliated Hospital of Nantong University, Nantong, Jiangsu, China
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Using paper clips to make simple, effective, and accessible auricular compression devices. Eur Arch Otorhinolaryngol 2023; 280:1155-1159. [PMID: 35945388 DOI: 10.1007/s00405-022-07591-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 08/04/2022] [Indexed: 02/07/2023]
Abstract
PURPOSE To investigate the early compression effects of adjustable pressure auricular clips, made of paper clips, during auricular surgery. METHODS 24 patients who underwent auricular surgery between August 2021 and April 2022 were selected as the study participants. Doctors used ear clips made of paper clips to prevent postoperative complications in these patients. RESULTS In all 24 patients, the wounds healed by stage I. Except for one case of minor local hematoma, all wounds healed well with no postoperative complications, such as subcutaneous hematoma formation, ulceration, or infected skin necrosis. Moreover, doctors were able to operate in lesser time and more conveniently with the help of the paper-clip devices. CONCLUSIONS This study proposes, for the first time, the use of paper clips to make ear clips with adjustable pressure. This simple device is easy to manufacture, inexpensive to the user, reliable in performance, and remarkable in its clinical effects. As such, the present study provides substantial evidence to suggest that this device should be widely applied in the clinical setting.
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Häussler D, Hüttemann S, Brom J, Rotter N, Sadick H. Long-Term Results of a Multimodal Treatment Regimen in Patients With Auricular Keloids. EAR, NOSE & THROAT JOURNAL 2022:1455613221133202. [PMID: 36314768 DOI: 10.1177/01455613221133202] [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: 12/22/2023] Open
Abstract
Objectives: The treatment of auricular keloids is challenging, as they tend to recur; further, the treatment may impact quality of life and implies cosmetic and functional impairment for each patient. There is no standardized therapeutic concept established, and the literature is lacking long-term results of available treatment modalities. Methods: Patients suffering from auricular keloids were included in the study. All patients had undergone surgical resection, intralesional injection of triamcinolone acetonide (TAC), and the application of an individual pressure splint. Quality of life (QoL) was assessed using the keloid intervention benefit inventory 21 (KIBI-21). Further analysis was carried out for patients without (group 1) and with (group 2) recurrence of the keloid. Results: In total, 50 keloids with a mean follow-up period of 59 months (range 6-137 months) could be analyzed. In nine cases (18%), a keloid recurrence was found during the observation period. The assessment of QoL differed significantly between study groups at P = 0.04, as well as for the subcategories General Health (GH) and Physical Health (PH). No differences were found for the categories Social Impact (SI) and Self-Esteem (SE). Conclusions: The multimodal subsequent treatment regimen consisting of surgical resection, intralesional TAC injection, and the application of an individual magnetic pressure splint shows good results concerning long-term recurrence rates. The treatment method shows positive effects on the QoL, especially in the measured categories GH and PH.
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Affiliation(s)
- Daniel Häussler
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Stefanie Hüttemann
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Jörn Brom
- Brom Epithetics, Heidelberg, Germany
| | - Nicole Rotter
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
| | - Haneen Sadick
- Department of Otorhinolaryngology Head and Neck Surgery, University Hospital Mannheim, Ruprecht-Karls-Universität Heidelberg, Heidelberg, Germany
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