瘢痕切除即刻局部注射曲安奈德联合放疗治疗耳廓瘢痕疙瘩疗效观察

目的:探讨手术切除,术中曲安奈德局部注射,术后放疗联合治疗耳廓瘢痕疙瘩的效果。方法:将病例分为三组:第一组:12例,24个瘢痕疙瘩(手术+曲安奈德注射+放疗),手术切除瘢痕疙瘩,术中注射醋酸曲安奈德,注射剂量依切缘大小而异,每次注射量不大于40mg,术后每周1次,连续4～8次,术后24h内行局部浅层放疗3天;第二组:11例,22个瘢痕疙瘩(手术+放疗),手术切除瘢痕疙瘩,术后24h内行放疗3天;第三组:17例,23个瘢痕疙瘩(手术+曲安奈德注射),手术切除瘢痕疙瘩,术中即刻注射曲安奈德,术后每周1次,连续4～8次。结果:第一组、第二组、第三组有效率分别为95.83%、77.27%、52.17%。第一组与第二组、第三组比较有显著差异(P<0.05)。结论:手术切除,术中曲安奈德局部注射联合术后放疗治疗耳廓瘢痕疙瘩副作用小、复发率低,值得临床应用。     

手术切除联合注射曲安奈德加放疗治疗瘢痕疙瘩的疗效观察

目的：评估手术切除联合术中注射曲安奈德加术后早期放射治疗瘢痕疙瘩的疗效。方法：110例患者随机分为对照组和治疗组,对149处瘢痕疙瘩全部行手术切除,治疗组术中在切缘处皮肤真皮内注射曲安奈德,术后24h内对手术部位行放射治疗。结果：术后切口均为I期愈合,术后随访12～24个月,治疗组治愈率为83．6％,与对照组58．2％相比较,P〈0．05。结论：手术切除瘢痕疙瘩,术中注射曲安奈德加早期术后放疗能够有效提高瘢痕疙瘩的治愈率。     

Fillet瓣联合术后磁铁片加压和曲安奈德注射治疗耳廓瘢痕疙瘩

目的 评价采取Fillet瓣联合术后磁铁片加压或并行曲安奈德注射综合治疗耳廓部瘢痕疙瘩的临床效果.方法 87例（102侧）女性耳廓瘢痕疙瘩患者,病变位于耳垂者73侧,位于耳轮者29侧,采取Fillet瓣联合术后磁铁片加压或并行曲安奈德注射综合治疗.结果 术后患者切口Ⅰ期愈合80例（94侧）,7例（8侧）出现皮瓣下血肿,皮瓣均成活;21例患者术后未进行加压及注射治疗,随访1年以上.术后压力治疗组及术后压力加注射治疗组疗效显著高于单纯手术组,差异有统计学意义;术后压力加注射治疗组疗效高于术后压力治疗组,但差异无统计学意义.结论 耳部瘢痕疙瘩采用Fillet瓣联合术后磁铁片加压或并行曲安奈德注射综合治疗,可取得满意效果.     

耳廓瘢痕疙瘩综合治疗的临床观察

目的评价手术联合曲安奈德局部注射治疗耳廓瘢痕疙瘩的临床效果。方法对12例(20侧)患者采用部分或全部切除耳廓瘢痕,皮瓣恢复耳廓正常外形。术后10 d切口及残余瘢痕内注射曲安奈德注射液,曲安奈德10~20 mg以2%利多卡因稀释1倍后注射,每2周1次,视瘢痕消退情况逐渐撤药。结果随访6~36个月,治愈8例,显效4例,有效率100%,疗效满意。结论手术联合曲安奈德局部注射是治疗耳廓瘢痕疙瘩的有效方法。     

耳垂瘢痕瓣结合磁铁片加压疗法的临床疗效观察

目的 探讨耳垂瘢痕瓣结合磁铁片加压疗法的临床治疗效果.方法 采用梭形切口,完整切除瘢痕疙瘩硬质核心后对位缝合.拆线2周后,耳垂前后佩戴磁铁片,每天佩戴8h以上,并保持加压(1.33～3.30kPa)状态半年以上.结果 本组患者切口Ⅰ期愈合者85例,2例出现血肿.所有患者随访12个月,治愈80例(87侧),显效5例(5侧),无一例复发.结论 耳垂瘢痕瓣结合磁铁片加压疗法治疗耳后瘢痕疙瘩,方法简便安全,可有效预防耳部瘢痕疙瘩术后复发.     

不同方法治疗耳垂瘢痕疙瘩的临床效果分析

目的:探讨手术切除和手术切除加局部注射曲安奈德治疗耳垂癜痕疙瘩的临床效果.方法:46饲耳垂癜痕疙瘩患者,随机分为手术切除组(A组)和手术切除加局部注射曲安奈德组(B组),每组23例.观察两组患者治疗后临床效果和不良反应.结果:A组治愈率为60.87%,B组治愈率为86.96%,与A比较,B组的治愈率明显较高,P<0.05,两组皆无严重并发症出现.结论:手术切除加局部注射曲安奈德能有效治疗耳垂癜痕疙瘩,美容效果好.     

耳部瘢痕疙瘩切除后减张及抗瘢痕治疗防止复发的疗效分析

目的：探讨耳部瘢痕疙瘩的治疗方法;方法：手术切除耳部瘢痕疙瘩后减张缝合＋伤口胶固定十硅酮凝胶,部分病例配合注射曲安奈德。结果：共治疗38例,失访6例,32例随访12个月,其中治愈27例（84．3％）,未界定3例（9．3％）,复发2例占随访病例6．2％。结论：耳部瘢痕疙瘩切除术后减张缝合＋伤口胶固定＋硅酮凝胶保水是综合治疗耳部瘢痕疙瘩防止复发的有效方法。     

手术切除联合多种方法治疗耳廓瘢痕疙瘩的临床观察

目的:观察手术切除耳廓瘢痕疙瘩后分别联合浅层X线放疗,切口内皮下注射糖皮质激素以及弹性鼻夹加压疗法治疗耳廓瘢痕疙瘩的疗效。方法:纳入耳垂瘢痕疙瘩患者150例,男26例,女124例,年龄6~51岁,平均年龄31.2岁,分为放疗组,注射组,加压组,每组各50例。手术方案:根据患者耳廓瘢痕具体特点,选择瘢痕整体切除直接缝合或局部皮瓣修复,瘢痕疙瘩核切除瘢痕瓣修复等方式以恢复耳廓外观形态。术后联合治疗方案:放疗组采用浅层X线放疗,单次剂量200 CGy,连续3d,1次/d,术后24h内进行第一次放疗,总剂量600CGy;注射组在切口缝合前在切口两侧皮下分别注射得宝松1次;加压组在拆线后使用弹性鼻夹加压手术切口3月。结果:三组病例术后切口均未出现感染迹象,外观基本正常。放疗组1例患者出现伤口延迟愈合,延迟拆线后外观正常。随访观察0.5~3年,放疗组4复发,注射组5例复发,加压组8例复发,在持续性外用硅酮膜和得宝松皮损内注射后消退。结论:手术切除瘢痕疙瘩或行瘢痕疙瘩核切除后配合浅层X线放疗,切口内糖皮质激素注射,弹性鼻夹加压治疗耳部瘢痕疙瘩疗效较为满意。可根据具体情况选择不同的方式联合进行。     

局部皮瓣在耳廓瘢痕疙瘩手术治疗中的应用

目的:探讨耳廓瘢痕疙瘩形成原因及手术治疗方法.方法:48例(50耳)耳廓瘢痕疙瘩行手术切除,局部皮瓣转移.术中应用改良菱形皮瓣27耳,皮下蒂"风筝"皮瓣23耳.手术切口缝合后,即刻向切口周围组织用稀释的曲安奈德注射液(2-4mg)少量浸润注射,伤口7天拆线.结果:2例耳轮处应用"风筝"皮瓣的尖端皮肤坏死,经换药后愈合良好:5例手术后3个月时瘢痕疙瘩有复发趋势,应局部注射稀释曲安奈德后好转.手术后术耳均能保持耳廓原有自然轮廓及解剖形态,不影响耳廓美观.结论:该手术术中切除耳廓瘢痕疙瘩,行局部皮瓣转移术,术中修补局部瘢痕疙瘩切除后所造成的皮肤缺损,术后保持耳廓自然解剖形态,不影响耳廓美观;手术过程简单,容易掌握,是良好的手术方法.     

瘢痕疙瘩发病及治疗后复发的临床相关因素分析

目的 总结分析瘢痕疙瘩发病及治疗后复发的相关因素.方法 对经手术切除＋放射治疗、曲安奈德局部注射、手术治疗＋药物外用3种治疗方法 的476例瘢痕疙瘩病例进行分析.结果 476例,22～45岁女性多发,女：男为1.83∶1.00;外伤与耳部穿孔是最常见的诱发原因;瘢痕疙瘩复发与家族史、治疗方法 、瘢痕位置有关,与患者年龄、性别、瘢痕大小、病程、发病诱因无关.结论 手术切除＋放射治疗、曲安奈德局部注射是较为有效的治疗方法,部分瘢痕疙瘩的发生与遗传有关,应重视瘢痕疙瘩的致病基因研究.     

Combination of different techniques for the treatment of earlobe keloids

Management of keloids is still controversial. Many different treatment modalities may be used for this purpose, however, no one method has been found completely successful. Therefore, we combined these techniques to improve therapeutic outcomes for earlobe keloids. Nine patients with earlobe keloids of a total number of 12 with auricular keloids were treated with a combined approach between 1995 and 2001. The keloids varied in size 2 × 1 to 5 × 3 cm and the patient age ranged 15–63 years. The patient group consisted of nine females, three males. Ear piercing was the main etiological factor for females. In the first session, surgical excision of the keloids was performed. It was followed with triamcinolone acetonide injection to the surgical field on the postoperative second week. Slight pressure was applied by silicone gel sheet coated earring for four months. No recurrence was noted in eight patients over longterm followup. One of nine patients had keloid recurrence. The authors found the results promising a combination of four techniques for treatment of ear lobe keloids is recommended even for recurrent lesions.     

Successful Treatment of Earlobe Keloids with Imiquimod after Tangential Shave Excision

BACKGROUND: The treatment of earlobe keloids has historically been suboptimal; characterized by discomfort, poor response, and high rates of recurrence. Keloids are characterized by increased fibroblast activity in the setting of an altered cytokine profile. OBJECTIVE: To investigate whether topical imiquimod 5% cream applied postoperatively after tangential excision can prevent recurrence of earlobe keloids. METHODS AND MATERIALS: Four patients with a total of eight large pedunculated earlobe keloids (five of which were recurrent lesions) were treated with debulking by tangential shave excision followed by daily application of imiquimod 5% cream for 6 weeks. RESULTS: At 6 and 12 months post-treatment there was an excellent cosmetic result and no evidence of recurrence in any of the lesions. Patients with keloids that were itchy and painful were completely asymptomatic at the conclusion of the study. CONCLUSION: In this pilot study, imiquimod 5% cream following tangential shave excision was efficacious for the treatment of earlobe keloids. Further study is warranted to confirm the utility of imiquimod 5% cream in the treatment of earlobe keloids, as illustrated herein.     

Failure of carbon dioxide laser excision of keloids

Seven patients with nine keloids have been treated by excision with the carbon dioxide laser. Eight of the nine keloids have recurred to their original or close to original size as early as 10 months following treatment and as late as 22 months. Keloids included in this study were located on the trunk, nuchal region, back, and earlobe. Only one patient (who underwent earlobe keloid excision) has greatly improved keloids after only 9 months follow-up, but this patient needs to wear pressure earrings continuously. The long-term benefits of keloid excision with the carbon dioxide laser is not demonstrated in this case study series.     

The efficacy of magnetic disks for the treatment of earlobe hypertrophic scar

Ear piercing has been widely performed for various reasons, but it may cause hypertrophic scarring and its attendant cosmetic problems and/or subjective symptoms, such as pruritus or pain. Many treatment methods have been applied alone or in combination, including surgical excision, steroid injection, compression, radiation, topical silicone application, and so on. Although each modality or combined therapy has its advantages and disadvantages, in the authors' opinion, compressive therapy combined with surgical excision is the most effective method in many respects. However, the peculiar shape of the earlobe does not allow for easy compression. Thus, many compressive devices have been developed that are not wholly satisfactory in terms of effectiveness, appearance, size, or convenience. The authors describe a newly developed method for the treatment of hypertrophic scarring of the earlobe that uses magnetic disks. They treated 47 patients (91 auricles) with a hypertrophic scar on the earlobe that underwent compressive therapy using magnetic disks after surgical excision from April to December 2002. The use of magnetic disks proved effective, and they believe that it offers many advantages as a compressive device.     

Treatment of earlobe keloids using the cobalt 60 teletherapy unit

The purpose of this study was to develop an easily accessible technique for the delivery of postoperative radiotherapy for the treatment of earlobe keloids. Forty-seven earlobe keloids were given postoperative radiation using the smallest achievable half field Telecobalt technique. Results showed 41 (87.2%) of treated patients' postoperative scars remained free from recurrent keloid formation. Acute reactions were minimal and patient compliance was excellent. In conclusion, the technique described in this study for the delivery of postoperative radiation to earlobe keloids should be readily available in areas of high prevalence. Results are comparable to previously used radiotherapy techniques.     

Postsurgical Use of Imiquimod 5% Cream in the Prevention of Earlobe Keloid Recurrences: Results of an Open-Label, Pilot Study

Background. Traditional surgical modalities for the management of earlobe keloids are often associated with high recurrence rates. A recent report suggests that imiquimod 5% cream can be effective in the prevention of keloid recurrences after surgical excision.
Method. To establish the safety and efficacy of imiquimod 5% cream in the prevention of recurrences of excised earlobe keloids.
Methods. Patients who attended a dermatologic surgery clinic for the treatment of earlobe keloids were recruited into the study. Earlobe keloids underwent parallel shave excision. Imiquimod 5% cream was applied daily for 8 weeks followed by an observation period of 16 weeks. In patients who presented with bilateral earlobe keloids, paired comparisons of imiquimod versus intralesional steroid injections were performed.
Results. Eight earlobes were treated with imiquimod 5% cream after parallel keloid removal. Twenty-four weeks after surgery, six (75%) remained recurrence free. Four patients underwent bilateral paired comparisons. At the end of the observation period, two patients (50%) remained recurrence free in the imiquimod-treated areas while experiencing recurrences in the intralesional steroid–treated areas. Local irritation secondary to imiquimod application required rest periods in three cases. In all cases, patients were able to resume therapy and completed the study without further complications.
Conclusion. Although small and uncontrolled, the results of this open-label, pilot study suggest that imiquimod 5% cream may prove to be a reasonably effective adjuvant therapeutic alternative for the prevention of recurrences in excised earlobe keloids.
DR. Martín-García HAS BEEN A CONSULTANT AND SPEAKER FOR 3M PHARMACEUTICALS.     

Successful treatment of earlobe keloids in the pediatric population

Background

Keloid scars present a difficult treatment challenge. Recently, intralesional steroid injection has become a common treatment modality [Akoz et al. Aesthetic Plast Surg. 2002;6:184-188; Studdiford et al. JABFM. 2008;21:149-152]. Although this has become a proven treatment technique, there is no standard injection protocol to which treating physicians commonly adhere. We hypothesize that timing of steroid injection may improve outcomes using this treatment technique in combination with lesion excision.

Methods

Fifteen patients with 16 earlobe keloids were treated using a standard steroid injection protocol with Kenalog (Bristol-Myers Squibb, New York, NY), in combination with lesion excision. Strict follow-up was enforced, with repeat injections as needed at any sign of abnormal scar formation postoperatively.

Results

Of 16 lesions, 15 (94%) were treated successfully with no sign of lesion recurrence at 6 months of follow-up. A single lesion was lost to follow-up and presented 18 months postoperatively with recurrence. This lesion was subsequently retreated successfully.

Conclusions

Kenalog injection in combination with excision is a well-tolerated and effective treatment of earlobe keloids in the pediatric population. We feel that timing of injection and adherence to a strict follow-up regimen is crucial to success.     

Bleomycin Tattooing as a Promising Therapeutic Modality in Large Keloids and Hypertrophic Scars

BACKGROUND: Cryotherapy combined with intralesional triamcinolon injection is the most common traditional therapy for hypertrophic scars and keloids. The literature contains few articles on the use of bleomycin tattoo for treatment of these conditions. OBJECTIVE: This study compares the efficacy of bleomycin tattoo with that of cryotherapy combined with intralesional triamcinolon injection for the treatment of keloids and hypertrophic scars. MATERIALS AND METHODS: Forty-five patients with hypertrophic scars or keloids were randomly divided into two groups. Group A was treated with bleomycin tattoo, and group B, with cryotherapy combined with intralesional triamcinolon injection. There were four therapeutic sessions at 1-month intervals. All patients were followed for 3 months after the end of treatment. RESULTS: Therapeutic response in lesions less than 100 mm2 was higher than 88% in both groups, but in larger lesions, the therapeutic response to bleomycin was significantly better than cryotherapy combined with intralesional triamcinolon injection (p = .03). In group A, no relationship was observed between therapeutic response and lesion size (p = .58); however, in group B smaller lesions (< 100 mm2) displayed better therapeutic response (p = .007). CONCLUSIONS: Bleomycin tattoo may be more effective than cryotherapy combined with intralesional triamcinolon injection in treatment of larger keloids and hypertrophic scars (size > 100 mm2).     

Combination therapy using non‐ablative fractional laser and intralesional triamcinolone injection for hypertrophic scars and keloids treatment

Combinations of various treatment modalities were shown to be more effective than monotherapy when treating hypertrophic scars and keloids. This study was conducted to assess the effectiveness of combination therapy with non‐ablative fractional laser and intralesional steroid injection. From May 2015 to June 2017, a total of 38 patients with hypertrophic scars or keloids were evaluated. The control group of 21 patients received steroid injection alone, and 17 patients (the combined group) received 1550‐nm erbium‐glass fractional laser treatment and steroid injection simultaneously. The mean number of treatment sessions was statistically fewer in the combined group than in the control group (6.95 vs 5.47, P = .042). There was a significant difference in the patient's scale in the combined group (14.62 vs 22.82, P = .005); however, the observer's scale was not significantly different (17.92 vs 20.55, P = .549). The recurrence rate was 38.1% (8/21) in the control group and 35.3% (6/17) in the combined groups and showed no significant difference (P = .859). However, the mean remission period was statistically longer in the combined group (3.00 months vs 4.17 months, P = .042). Combination therapy with non‐ablative fractional laser and intralesional steroid injection showed better results for the treatment of hypertrophic scars and keloids with fewer treatment sessions, better patient satisfaction, and longer remission periods.