Thierauf Julia, Walther M, Rotter N, Scheithauer M-O, Hoffmann T K, Veit J A
Department of Otorhinolaryngology, Head and Neck Surgery, Ulm University Medical Center, Frauensteige 12, 89075, Ulm, Germany.
Faculty of Medicine, Ludwig-Maximilian-University, Munich, Germany.
Eur Arch Otorhinolaryngol. 2017 Nov;274(11):3859-3866. doi: 10.1007/s00405-017-4714-5. Epub 2017 Aug 20.
Keloids are benign cutaneous lesions, arising from proliferating fibroblasts. Keloids of the ear may occur after trauma, surgery or helix piercings and are difficult to treat, since they tend to form recurrences. Guidelines suggest multimodal therapy; however, recurrence rates remain high and distinct algorithms for the combination of different modalities are missing. To unravel the most effective combination of therapeutic options for keloids of the ear, 38 patients with the diagnosis of an ear keloid were included in our cohort. In a prospective subgroup (B) of this cohort (n = 17), patients either underwent surgery using the "fillet technique" (a meticulous peeling of the keloid skin) and intra-lesional injections of triamcinolone 10 mg/ml every 4-6 weeks for 6 months, or they were additionally treated with a non-customized pressure device which was recommended for at least 16/24 h per day over 6 months. To further compare our results, the remaining 21 patients of our cohort, who were treated at our clinic before, were retrospectively evaluated concerning their recurrence rates. The mean follow-up was 48 months. The mean count of adjuvant steroid injections was two in all patients, four in subgroup B. The recurrence rate was 30% (13/38) in all patients (subgroup B 0/17). Aesthetic results were good to excellent in all non-recurrent cases. No patient treated with fillet technique showed recurrence (p < 0.001). However, we could not confirm a significant effect but a trend of repeated steroid injections for preventing recurrences (p = 0.099). The application of pressure using our non-customized clip also showed a clear trend towards preventing recurrences in cross-table analysis (p = 0.057). Although several studies on different treatment regimens for keloids of the ear exist, the effectiveness of a multimodal treatment regimen needs to be elucidated. Overall, the best results in preventing recurrences were achieved by combining three different treatments. However, the fillet technique was the only modality preventing recurrences of keloids in uni- and multivariate analysis. The application of pressure with a non-customized clip and repeated steroid injections also showed a positive trend but failed level of significance. Based on our data and the literature we recommend, when feasible, the combination of more than one therapeutic regimen, since relapse risk went down from single to dual and triple therapy from 40% (8/20) to 14.3% (2/14) to 0% (0/4), respectively in our cohort. The use of "fillet technique" was especially beneficial.
瘢痕疙瘩是由成纤维细胞增殖引起的良性皮肤病变。耳部瘢痕疙瘩可发生于创伤、手术后或耳垂穿孔后，且难以治疗，因为它们容易复发。指南建议采用多模式治疗；然而，复发率仍然很高，且缺乏不同治疗方式联合使用的明确算法。为了找出治疗耳部瘢痕疙瘩最有效的治疗方案组合，我们的队列纳入了38例诊断为耳部瘢痕疙瘩的患者。在该队列的一个前瞻性亚组（B组，n = 17）中，患者要么接受使用“鱼片技术”（精细剥离瘢痕疙瘩皮肤）的手术，并每4 - 6周进行一次皮损内注射10 mg/ml曲安奈德，持续6个月，要么额外使用一种非定制压力装置进行治疗，该装置建议每天至少使用16/24小时，持续6个月。为了进一步比较我们的结果，对我们队列中之前在我们诊所接受治疗的其余21例患者的复发率进行了回顾性评估。平均随访时间为48个月。所有患者辅助性类固醇注射的平均次数为2次，B组为4次。所有患者的复发率为30%（13/38）（B组为0/17）。所有未复发病例的美学效果均为良好至优秀。采用鱼片技术治疗的患者均未出现复发（p < 0.001）。然而，我们无法证实重复注射类固醇对预防复发有显著效果，但有这种趋势（p = 0.099）。在交叉表分析中，使用我们的非定制夹子施加压力也显示出明显的预防复发趋势（p = 0.057）。尽管存在几项关于耳部瘢痕疙瘩不同治疗方案的研究，但多模式治疗方案的有效性仍需阐明。总体而言，通过联合三种不同治疗方法在预防复发方面取得了最佳效果。然而，在单变量和多变量分析中，鱼片技术是唯一能预防瘢痕疙瘩复发的治疗方式。使用非定制夹子施加压力和重复注射类固醇也显示出积极趋势，但未达到显著水平。根据我们的数据和文献，我们建议在可行的情况下联合使用多种治疗方案，因为在我们的队列中，复发风险从单一治疗到双重治疗再到三重治疗分别从40%（8/20）降至14.3%（2/14）再降至0%（0/4）。使用“鱼片技术”尤其有益。
