Hadedeya Deena, Shalaby Mahmoud, Akkera Mounika, Lee Grace, Harris Kendra, Kholmatov Roostam, Anwar Muhammad, Murad Fadi, Alawaad Saad, Kandil Emad
Department of Surgery, Tulane University School of Medicine, New Orleans, LA, USA.
Department of Radiation Oncology, Tulane University School of Medicine, New Orleans, LA, USA.
Gland Surg. 2021 Jan;10(1):65-72. doi: 10.21037/gs-20-511.
Poor cosmesis, secondary to keloid or hypertrophic scar, following thyroid surgery may cause considerable patient distress and be a significant challenge to treat. In this case series we examined the efficacy of prophylactic external beam radiation therapy (EBRT) for prevention of keloid formation in keloid-prone patients undergoing thyroid surgery. While much has been published about documenting the efficacy in reducing keloid formation following keloid excision, very little literature exists documenting prophylactic use related to surgeries with the goal of prevent keloid formation.
We retrospectively evaluated a series of ten patients, who underwent a prophylactic EBRT for keloid prevention after thyroid surgery between January 2013 and February 2019. Patient demographics, primary diagnosis, surgical procedure, EBRT dosage, and post-operative visit records were reviewed.
All ten patients who received EBRT for keloid prophylaxis following a thyroid surgery were female. Half of the patients were African Americans, 40% Caucasians, and 10% Hispanic. The mean age was 46.40±15.63 years with BMI of 31.5±5.5 kg/m. Radiation was initiated within 6 hours of the surgery with an average radiation dose per session of 5.7±1.7 Gy. The total average EBRT dose delivered was 17.4±4.2 Gy. Mean follow-up period was 13 months post-thyroidectomy, with the longest follow-up at 23 months. One patient, who underwent a lateral neck dissection in addition to thyroid surgery, developed hypertrophic scar in less than 10% of her incision length. Nine other patients (90%) showed no post-surgical keloid nor hypertrophic scar formation and patients were satisfied with postsurgical cosmesis.
We examined the efficacy of prophylactic EBRT in keloid-prone patients undergoing thyroid surgery. Prophylactic EBRT following thyroid surgery is effective in achieving a satisfactory cosmetic outcome in patients at high risk for keloid formation.
甲状腺手术后因瘢痕疙瘩或增生性瘢痕导致的美容效果不佳，可能会给患者带来极大困扰，且治疗颇具挑战。在本病例系列中，我们研究了预防性外照射放疗（EBRT）对易形成瘢痕疙瘩的甲状腺手术患者预防瘢痕疙瘩形成的疗效。虽然已有大量文献记录了EBRT在瘢痕疙瘩切除后减少瘢痕疙瘩形成的疗效，但关于以预防瘢痕疙瘩形成为目的的手术预防性使用EBRT的文献却很少。
我们回顾性评估了2013年1月至2019年2月期间接受预防性EBRT以预防甲状腺手术后瘢痕疙瘩形成的10例患者。回顾了患者的人口统计学资料、初步诊断、手术过程、EBRT剂量以及术后随访记录。
所有10例接受甲状腺手术后预防性EBRT的患者均为女性。一半患者为非裔美国人，40%为白种人，10%为西班牙裔。平均年龄为46.40±15.63岁，体重指数为31.5±5.5kg/m。放疗在手术后6小时内开始，每次放疗平均剂量为5.7±1.7Gy。EBRT总平均剂量为17.4±4.2Gy。甲状腺切除术后平均随访期为13个月，最长随访期为23个月。1例除甲状腺手术外还接受了侧颈清扫术的患者，其切口长度不到10%出现了增生性瘢痕。其他9例患者（90%）术后未出现瘢痕疙瘩或增生性瘢痕形成，患者对手术美容效果满意。
我们研究了预防性EBRT对易形成瘢痕疙瘩的甲状腺手术患者的疗效。甲状腺手术后预防性EBRT对于瘢痕疙瘩形成高危患者可有效实现令人满意的美容效果。
