Archives of Craniofacial Surgery (대한두개안면성형외과학회지)

Korean Cleft Palate-Craniofacial Association (대한두개안면성형외과학회)
권호 표지
DOI QR코드

DOI QR Code

Clinical efficacy of intermittent magnetic pressure therapy for ear keloid treatment after excision

  • Jun, Dongkeun (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Shin, Donghyeok (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Choi, Hyungon (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine) ;
  • Lee, Myungchul (Department of Plastic and Reconstructive Surgery, Konkuk University School of Medicine)
  • Received : 2019.09.05
  • Accepted : 2019.10.21
  • Published : 2019.12.20
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Keloids are benign fibro-proliferative lesion, related to excessive inflammatory reactions in certain anatomical areas, including the auricles. Their specific etiology remains unclear; nonetheless they exhibit tumor-like characteristics of significant recurrence and cause emotional distress, even with various treatment strategies. We applied intermittent magnetic pressure therapy on ear keloids in combination with surgical excision, and present its effectiveness herein. Methods: Ear keloid patients were treated with surgical excision followed by magnetic pressure therapy. The keloid tissues underwent excision and keloid marginal flaps were utilized for wound closure. Intermittent magnetic pressure therapy was applied 2 weeks after the surgical procedure. The pressure therapy consisted of a 3-hour application and 2-hour resting protocol (9 hr/day), and lasted for 6 months. The results were analyzed 6 months after the therapeutic procedures, using the scar assessment scale. Results: Twenty-two ear keloids from 20 patients were finally reviewed. Among the keloids that completed the therapeutic course, 20 ear keloids out of 22 in total (90.9%) were successfully eradicated. Two patients (2 keloids) exhibited slight under-correction. Postoperative complications such as wound dehiscence or surgical site infection were not noted. The scar assessment scale demonstrated a significant improvement in each index. The intermittent pressure therapy led to patient compliance, and avoided pressure-related pain and discomfort. Conclusion: Excision followed by intermittent pressure application using a magnet successfully reduced the burden of fibro-proliferative keloids, and had good patient compliance. The role of intermittent pressure application and resting should be studied with regard to keloid tissue remodeling.

Keywords

References

  1. Unahabhokha T, Sucontphunt A, Nimmannit U, Chanvorachote P, Yongsanguanchai N, Pongrakhananon V. Molecular signalings in keloid disease and current therapeutic approaches from natural based compounds. Pharm Biol 2015;53:457-63. https://doi.org/10.3109/13880209.2014.918157
  2. Andrews JP, Marttala J, Macarak E, Rosenbloom J, Uitto J. Keloids: the paradigm of skin fibrosis-pathomechanisms and treatment. Matrix Biol 2016;51:37-46. https://doi.org/10.1016/j.matbio.2016.01.013
  3. Jones ME, McLane J, Adenegan R, Lee J, Ganzer CA. Advancing keloid treatment: a novel multimodal approach to ear keloids. Dermatol Surg 2017;43:1164-9. https://doi.org/10.1097/DSS.0000000000001145
  4. Akoz T, Gideroglu K, Akan M. Combination of differenchniques for the treatment of earlobe keloids. Aesthetic Plast Surg 2002;26:184-8. https://doi.org/10.1007/s00266-002-1490-3
  5. Park TH, Seo SW, Kim JK, Chang CH. Outcomes of surgical excision with pressure therapy using magnets and identification of risk factors for recurrent keloids. Plast Reconstr Surg 2011;128:431-9. https://doi.org/10.1097/PRS.0b013e31821e7006
  6. Tanaydin V, Beugels J, Piatkowski A, Colla C, van den Kerckhove E, Hugenholtz GC, et al. Efficacy of custom-made pressure clips for ear keloid treatment after surgical excision. J Plast Reconstr Aesthet Surg 2016;69:115-21. https://doi.org/10.1016/j.bjps.2015.09.013
  7. Daya M, Nair V. Traction-assisted dermatogenesis by serial intermittent skin tape application. Plast Reconstr Surg 2008;122:1047-54. https://doi.org/10.1097/PRS.0b013e3181858c68
  8. Shim HS, Choi JS, Kim SW. A role for postoperative negative pressure wound therapy in multitissue hand injuries. Biomed Res Int 2018;2018:3629643.
  9. Chowdhry SA, Wilhelmi BJ. Comparing negative pressure wound therapy with instillation and conventional dressings for sternal wound reconstructions. Plast Reconstr Surg Glob Open 2019;7:e2087. https://doi.org/10.1097/GOX.0000000000002087
  10. Park TH, Rah DK. Successful eradication of helical rim keloids with surgical excision followed by pressure therapy using a combination of magnets and silicone gel sheeting. Int Wound J 2017;14:302-6. https://doi.org/10.1111/iwj.12547
  11. Chang CH, Song JY, Park JH, Seo SW. The efficacy of magnetic disks for the treatment of earlobe hypertrophic scar. Ann Plast Surg 2005;54:566-9. https://doi.org/10.1097/01.sap.0000152529.02954.07
  12. Reno F, Sabbatini M, Lombardi F, Stella M, Pezzuto C, Magliacani G, et al. In vitro mechanical compression induces apoptosis and regulates cytokines release in hypertrophic scars. Wound Repair Regen 2003;11:331-6. https://doi.org/10.1046/j.1524-475X.2003.11504.x
  13. Reno F, Sabbatini M, Stella M, Magliacani G, Cannas M. Effect of in vitro mechanical compression on Epilysin (matrix metalloproteinase-28) expression in hypertrophic scars. Wound Repair Regen 2005;13:255-61. https://doi.org/10.1111/j.1067-1927.2005.130307.x
  14. Thompson CB. Apoptosis in the pathogenesis and treatment of disease. Science 1995;267:1456-62. https://doi.org/10.1126/science.7878464
  15. Kawamoto Y, Nakajima YI, Kuranaga E. Apoptosis in Cellular Society: communication between apoptotic cells and their neighbors. Int J Mol Sci 2016;17:E2144. https://doi.org/10.3390/ijms17122144
  16. Wassermann RJ, Polo M, Smith P, Wang X, Ko F, Robson MC. Differential production of apoptosis-modulating proteins in patients with hypertrophic burn scar. J Surg Res 1998;75:74-80. https://doi.org/10.1006/jsre.1998.5267
  17. Chodon T, Sugihara T, Igawa HH, Funayama E, Furukawa H. Keloid-derived fibroblasts are refractory to Fas-mediated apoptosis and neutralization ofautocrine transforming growth factor-beta1 can abrogate this resistance. Am J Pathol 2000;157:1661-9. https://doi.org/10.1016/S0002-9440(10)64803-1
  18. Shoman K, Sato Y, Nishikawa E, Kudo Y, Yamamoto T, Iida J. Evaluation of the effectiveness of intermittent mechanical pressure with short loading duration: new type of intermittent force for orthodontic treatment. Eur J Orthod 2017;39:264-9. https://doi.org/10.1093/ejo/cjx009
  19. Sundby OH, Hoiseth LO, Mathiesen I, Jorgensen JJ, Weedon-Fekjer H, Hisdal J. Application of intermittent negative pressure on the lower extremity and its effect on macro- and microcirculation in the foot of healthy volunteers. Physiol Rep 2016;4:e12911. https://doi.org/10.14814/phy2.12911
  20. Stahl S, Barnea Y, Weiss J, Amir A, Zaretski A, Leshem D, et al. Treatment of earlobe keloids by extralesional excision combined with preoperative and postoperative "sandwich" radiotherapy. Plast Reconstr Surg 2010;125:135-41.
  21. Lee Y, Minn KW, Baek RM, Hong JJ. A new surgical treatment of keloid: keloid core excision. Ann Plast Surg 2001;46:135-40. https://doi.org/10.1097/00000637-200102000-00008