Department of Plastic Surgery, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Department of Dermatology, Sichuan Provincial People's Hospital, School of Medicine, University of Electronic Science and Technology of China, Chengdu, China.
Radiother Oncol. 2024 Oct;199:110425. doi: 10.1016/j.radonc.2024.110425. Epub 2024 Jul 14.
Retaining partial keloid skin to make cross flaps (keloid-cross-flap surgery) is a modification of the core excision. This study aimed to compare the effectiveness of superficial radiotherapy versus compression therapy after keloid-cross-flap surgery.
In this prospective cohort study, auricular keloid patients were consecutively screened from January 2019 to December 2021. They underwent keloid-cross-flap surgery and then enter either the superficial radiotherapy or the compression treatment group. The primary outcome was the one-year keloid recurrence rate. Secondary outcomes included: non-completion rate of adjuvant treatment; Patient and Observer Scar Assessment Scale (POSAS) scores and auricular aesthetics scores, evaluated by a four-point Likert scale (1 = poor to 4 = excellent) of non-recurring patients. Propensity score matching (PSM) was used to eliminate potential confounding factors.
123 patients were included in the superficial radiotherapy group and 128 in the compression treatment group. Non-completion rate was significantly higher in the compression treatment group (17.97 %), while the loss rate was comparable between the two groups. Overall, 13 patients (13.54 %) relapsed in superficial radiotherapy group, while 22 patients (25.58 %) in compression group (p < 0.05). After PSM, 59 patients in each group were analyzed, and the recurrence rate was lower in the superficial radiotherapy group (13.56 %). Of relapse-free patients, no significant difference was found in PSAS scores, OSAS scores or aesthetic scores between the two groups.
Keloid-cross-flap surgery could provide favorable morphologic repair of the auricular keloid, and postoperative superficial radiotherapy shows higher compliance and lower recurrence rate comparing to compression treatment.
保留部分瘢痕皮肤制作交叉皮瓣（瘢痕交叉皮瓣手术）是核心切除的一种改良。本研究旨在比较瘢痕交叉皮瓣手术后浅层放疗与压迫治疗的效果。
本前瞻性队列研究连续筛选了 2019 年 1 月至 2021 年 12 月期间的耳廓瘢痕患者。他们接受了瘢痕交叉皮瓣手术，然后进入浅层放疗或压迫治疗组。主要结局是一年后瘢痕复发率。次要结局包括：辅助治疗未完成率；非复发患者的患者和观察者瘢痕评估量表（POSAS）评分和耳廓美学评分，采用 4 分 Likert 量表（1=差至 4=优）进行评估。采用倾向评分匹配（PSM）消除潜在混杂因素。
浅层放疗组 123 例，压迫治疗组 128 例。压迫治疗组未完成率明显较高（17.97%），但两组失访率相似。总体而言，浅层放疗组 13 例（13.54%）患者复发，而压迫组 22 例（25.58%）（p<0.05）。PSM 后，每组分析 59 例，浅层放疗组复发率较低（13.56%）。在无复发患者中，两组的 PSAS 评分、OSAS 评分或美学评分无显著差异。
瘢痕交叉皮瓣手术可为耳廓瘢痕提供良好的形态修复，术后浅层放疗与压迫治疗相比，具有更高的依从性和更低的复发率。
