Bhattacharya Neela, Bhattacharya Kaushik, Chandran T C
Department of Plastic Surgery, Anandaloke Multispeciality Hospital, Siliguri, West Bengal, India.
Department of General Surgery, CAPF Composite Hospital, Siliguri, West Bengal, India.
Indian J Plast Surg. 2023 Feb 21;56(3):251-259. doi: 10.1055/s-0043-1761599. eCollection 2023 Jun.
The treatment of keloidal scars with radiotherapy has been practiced for more than a century. Radiotherapy post-surgery has been deemed necessary and effective in preventing recurrence but still, no clear guidelines exist as to the best modality of radiotherapy, the ideal dose, and the time it should be given for keloidal scars. The purpose of this study is to confirm the effectiveness of this treatment and address these issues. Since 2004, 120 patients presenting with keloidal scars were seen by the author. Out of them, 50 were managed with surgery followed by HDR brachytherapy/electron beam radiotherapy delivering 2000 rads to the scar within 24 hours of surgery. Patients were followed up for at least 18 months to assess the scar status and the recurrence of keloids. Recurrence was defined as the appearance of a nodule or an obvious return of the keloid within 1 year of treatment. Three patients developed a nodule in the scar, which was deemed a recurrence, making an incidence of 6%. There was no major problem after immediate postoperative radiotherapy. Five patients had delayed healing at 2 weeks and a hypertrophic scar was noted in five patients at 4 weeks that settled with conservative measures. Treating the vexing problem of keloids with surgery and immediate postoperative radiotherapy is safe and effective. We recommend that this be adopted as the standard treatment in keloid management.
放射疗法治疗瘢痕疙瘩已有一个多世纪的历史。术后放疗被认为对预防复发是必要且有效的，但对于瘢痕疙瘩放疗的最佳方式、理想剂量以及放疗时间，目前仍没有明确的指导方针。本研究的目的是证实这种治疗方法的有效性并解决这些问题。
自2004年以来，作者共接诊了120例瘢痕疙瘩患者。其中50例接受了手术治疗，术后在24小时内对瘢痕进行了高剂量率近距离放疗/电子束放疗，剂量为2000拉德。对患者进行了至少18个月的随访，以评估瘢痕状况和瘢痕疙瘩的复发情况。复发定义为治疗后1年内瘢痕内出现结节或瘢痕疙瘩明显复发。
3例患者瘢痕内出现结节，被视为复发，复发率为6%。术后即刻放疗后未出现重大问题。5例患者在术后2周愈合延迟，4周时5例患者出现增生性瘢痕，经保守治疗后好转。
手术联合术后即刻放疗治疗瘢痕疙瘩这一棘手问题是安全有效的。我们建议将其作为瘢痕疙瘩治疗的标准方法。
