Lamba Randeep Singh, Pargal Pinki, Salwan Anurag, P M Junaise, Nigam Pallavi, Bansal Noopur
Department of Plastic and Reconstructive Surgery, Christian Medical College, Ludhiana, Punjab, India.
Indian J Plast Surg. 2025 Jan 17;58(2):105-109. doi: 10.1055/s-0044-1801403. eCollection 2025 Apr.
Any deviation from the normal process of wound healing leads to excessive scar formation in the form of keloid or hypertrophic scar. The study included 120 candidates with keloids divided equally into two groups, A and B, of 60 patients each. After surgical excision, group A received combination therapy of intramarginal 5-fluorouracil (5-FU) and triamcinolone acetonide (TCA), while group B received only TCA, followed by compression therapy in both. Eighty-seven patients had keloids on ear lobules, 25 (20.8%) on helix, and 8 (6.7%) over multiple locations on ear. Ninety-two (76.7%) had keloids over bilateral, 18 (15%) on left, and 10 (8.3%) on right ear. Sixty-three (52.5%) belonged to third, 65 (54.2%) to fourth, and 8 (6.7%) to fifth decade of life. Overall recurrence rate was 21.7 and 38.3% in group A and B, respectively. Recurrence was seen in 2 from group A (male:female 2:0) and 4 from group B (male:female 3:1) at 3 months, in 7 from group A (male:female 5:2) and 13 in group B (male:female 8:5) at 6 months, and in 4 from group A (male:female 3:1) and 6 from group B (male:female 5:1) at 1 year. Overall, pain was reported by 9 and 7 from group A and B, respectively, and burning sensation by 3 and 1 from group A and B, respectively. Ulceration was noted in 2, wound dehiscence in 1 and transient hyperpigmentation in 2 from group A. Based on the Vancouver Scar Scale, outcome on follow-up had an average of 3.5 at 3 months, 4.2 at 6 months, and 4.8 at 1 year in group A, and 3.8 at 3 months, 4.7 at 6 months, and 5.4 at 1 year in group B. Multimodal approach of combination therapy of intramarginal 5-FU and TCA with compression therapy after surgical excision of keloids in ears yields lower recurrence rate when compared with TCA alone. Chances of recurrence are more common in males than females. Though intramarginal 5-FU in combination with TCA has more localized side effects than TCA alone yet lower recurrence rate and better results in the long term can overcome the mild severity of these side effects.
伤口愈合的正常过程出现任何偏差都会导致瘢痕疙瘩或增生性瘢痕形式的过度瘢痕形成。该研究纳入了120例瘢痕疙瘩患者，平均分为A、B两组，每组60例。手术切除后，A组接受边缘注射5-氟尿嘧啶（5-FU）和曲安奈德（TCA）的联合治疗，而B组仅接受TCA治疗，两组随后均接受压迫治疗。87例患者的瘢痕疙瘩位于耳垂，25例（20.8%）位于耳轮，8例（6.7%）位于耳部多个位置。92例（76.7%）双侧有瘢痕疙瘩，18例（15%）在左耳，10例（8.3%）在右耳。63例（52.5%）年龄在第三个十年，65例（54.2%）在第四个十年，8例（6.7%）在第五个十年。A组和B组的总体复发率分别为21.7%和38.3%。3个月时，A组有2例复发（男:女为2:0），B组有4例复发（男:女为3:1）；6个月时，A组有7例复发（男:女为5:2），B组有13例复发（男:女为8:5）；1年时，A组有4例复发（男:女为3:1），B组有6例复发（男:女为5:1）。总体而言，A组和B组分别有9例和7例报告有疼痛，A组和B组分别有3例和1例报告有烧灼感。A组有2例出现溃疡，1例伤口裂开，2例出现短暂色素沉着。根据温哥华瘢痕量表，随访结果显示，A组在3个月、6个月和1年时的平均得分分别为3.5、4.2和4.8，B组在3个月、6个月和1年时的平均得分分别为3.8、4.7和5.4。耳部瘢痕疙瘩手术切除后，边缘注射5-FU和TCA联合压迫治疗的多模式方法与单独使用TCA相比，复发率更低。男性比女性更容易复发。虽然边缘注射5-FU与TCA联合使用比单独使用TCA有更多局部副作用，但较低的复发率和长期更好的效果可以克服这些副作用的轻度严重性。
