Ali A, Xiao-Dong C
Dr Ahmed Ali, Department of Dermatology and Venereology, Affiliated Hospital of Nantong University, Nantong, China; E-mail:
Mymensingh Med J. 2021 Jul;30(3):816-825.
Keloids always remain a great challenge due to limited surgical treatment options. Most treatments e.g. surgery, drug therapy, radiotherapy, laser therapy, and cryotherapy for managing keloids have very limited effectiveness, for keloids grow slowly but progressively and the recurrence rate is inappreciably high. Skin expansion constitutes a potential treatment option in the treatment of large keloid. This study was intended to determine the clinical outcome of 'Tissue Expander beneath the Keloid Surgery' for repair of wound formed as a result of excision of relatively large keloids. This retrospective study was done in the Department of Dermatology and Venereology of Nantong University-affiliated Hospital, China. Using a quasi-experimental design, from August 2006 to August 2017, 75 keloids in 70 patients were implanted with tissue expanders, the capacity of which was 70-600ml. After 50-126 days of implantation, the intralesional excision with flap advancement surgery was carried out. During intraoperative period, keloid lesions were treated with beta methasone injection as 0.2ml per sq. cm of lesion and the total dose should not normally over 1-2ml per dose and postoperative superficial electron beam irradiation. Post-operative follow-up ranged from 12 to 50 months. All patients underwent keloid resection followed by radiation at postoperative day 1 and 8 with a total dose 16-18 Gy. The patient and observer scar assessment scales (POSAS) were used to evaluate changes in keloids pre- and post-operatively. Among 75 keloids, 71(94.7%) (Including 11 keloids combined with the infected site) demonstrated successful outcome, 4(5.3%) expanders in the chest failed. Infection occurred in 4(5.3%) keloids during expansion process which led to early removal of expander resulting in failure of the operation, while in the remaining 71 sites, the entire treatment process was successfully completed. Follow-up was done for more than 12 months, when 14 sites (all anterior chest) exhibited local recurrence. There was no recurrence in the 14 sites of pubic region. The total POSAS scores before surgery were 59.3±13.6 which significantly reduced to 17.7±9.1 after 12 months of surgery (p<0.001). Soft tissue expanders implantation beneath the keloid is one of the ideal methods to treat relatively large keloids, formed as a result of excision of relatively large keloids, provided the patients are carefully selected based on knowledge about possible complications.
由于手术治疗选择有限，瘢痕疙瘩一直是一个巨大的挑战。大多数治疗方法，如手术、药物治疗、放射治疗、激光治疗和冷冻治疗瘢痕疙瘩的效果都非常有限，因为瘢痕疙瘩生长缓慢但持续不断，复发率相当高。皮肤扩张术是治疗大面积瘢痕疙瘩的一种潜在治疗选择。本研究旨在确定“瘢痕疙瘩手术下方组织扩张器”修复因切除相对较大瘢痕疙瘩而形成的伤口的临床效果。这项回顾性研究在中国南通大学附属医院皮肤科和性病科进行。采用准实验设计，从2006年8月至2017年8月，对70例患者的75个瘢痕疙瘩植入了容量为70 - 600ml的组织扩张器。植入50 - 126天后，进行病灶内切除并推进皮瓣手术。术中，瘢痕疙瘩病灶每平方厘米注射0.2ml倍他米松，每剂总量通常不超过1 - 2ml，并进行术后浅表电子束照射。术后随访时间为12至50个月。所有患者在术后第1天和第8天接受瘢痕疙瘩切除并进行放疗，总剂量为16 - 18Gy。采用患者和观察者瘢痕评估量表（POSAS）评估瘢痕疙瘩术前和术后的变化。在75个瘢痕疙瘩中，71个（94.7%）（包括11个合并感染部位的瘢痕疙瘩）显示治疗成功，胸部的4个（5.3%）扩张器失败。4个（5.3%）瘢痕疙瘩在扩张过程中发生感染，导致扩张器提前取出，手术失败，而在其余71个部位，整个治疗过程成功完成。随访超过12个月时，14个部位（均在前胸）出现局部复发。耻骨区域的14个部位未复发。术前POSAS总评分为59.3±13.6，术后12个月显著降至17.7±9.1（p<0.001）。在瘢痕疙瘩下方植入软组织扩张器是治疗因切除相对较大瘢痕疙瘩而形成的相对较大瘢痕疙瘩的理想方法之一，前提是根据对可能并发症的了解仔细选择患者。
