Background
A keloid is a pathologic response to wound healing of that occurs as a result of the hyperproliferation of dermal collagen in response to skin injury.₁ Dense, benign growths by definition, keloids (vs. hypertrophic scars), extend beyond the borders of the original wound invading normal skin. These lesions may occur over any skin surface, but predominantly occur over the neck, ears, shoulders, and tend to arise secondary to piercing, trauma, or burns. All racial groups are affected, yet epidemiologic data suggests that the incidence and overall risk is higher among people of color._2-4 Multiple modalities have been described in the literature to target these lesions, but treatment and prevention of keloid formation continues to present a therapeutic challenge to the plastic surgeon due to the increased rate of recurrence. Recurrence rates with all modalities have been reported to be from 0-100%.₆ Previous studies have examined the use of a staged procedure with initial excision and split thickness skin grafting followed by delayed lobule reconstruction.₅
Methods
We studied the rate of recurrence of auricular keloids via a technique previously described in the literature ₇, but over a series of patients. Keloids were treated with total excision in combination with coverage of the resulting defect with a full thickness skin graft and intradermal injection of triamcinolone acetonide (Kenalog) solution at the periphery of the donor and recipient sites.
Results
From April 2006- February 2007, 10 patients with 10 auricular keloids ranging 2-10cm were done utilizing this technique and in a follow-up of up to 11 months (mean 7.37 months), no recurrence was observed.
Conclusions
These results support that full-thickness skin grafts can be used to address keloid lesions without recurrence, justifying the need for further studies are needed to ascertain the overall efficacy of this technique.
References
1. Olabanji JK, et. al. Keloids: an old problem still searching for a solution. Surg Pract 2005;9:2-7.
2. A.E. Brissett and D.A. Sherris, Scar contractures, hypertrophic scars, and keloids, Facial Plast Surg 17 (2001), pp. 263-272.
3. Kelly AP. Medical and surgical therapies for keloids. Dermatol Ther 2004; 17:212-8.
4. Robles DT, Berg D. Abnormal wound healing: keloids. Clin. Dermatol. 2007 Jan-Feb; 25(1): 26-32.
5. Saha SS, et. al. Primary skin grafting in ear lobule keloid. Plast Reconst Surg 2004 Oct;114(5):1204-7
6. Porter, JP. Treatment of Keloids: What is new? Otolaryngol Clin North Am. Feb 2002; 35 (1): 207-20, viii
7. Converse JM, Stallings JO. Eradication of large auricular keloids by excision, skin grafting, and intradermal injection of triamcinolone acetonide solution Case report. Plast Reconstr Surg. 1972 Apr;49(4):461-3