• Korean Journal of Bronchoesophagology
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• v.7 no.1
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• pp.71-75
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• 2001

Keloid of earlobe is one of the most common complications of ear-piercing. Various modalities of treatment have been tried to relieve frequent recurrences of the disease, not showing complete success. We have experienced a case of earlobe keloid, which had recurred after primary surgery, and was treated with secondary surgical excision and intra- and Post-operative topical injections of triamcinolone acetonide.

• Archives of Craniofacial Surgery
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• v.20 no.6
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• pp.354-360
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• 2019

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.

• Archives of Craniofacial Surgery
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• v.17 no.1
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• pp.5-8
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• 2016

Background: Lobular keloid appears to be a consequence of hypertrophic inflammation secondary to ear piercings performed under unsterile conditions. We wish to understand the pathogenesis of lobular keloids and report operative outcomes with a literature review. Methods: A retrospective review identified 40 cases of lobular keloids between January, 2005 and December, 2010. Patient records were reviewed for preclinical factors such as presence of inflammation after ear piercing prior to keloid development, surgical management, and histopathologic correlation to recurrence. Results: The operation had been performed by surgical core extirpation or simple excision, postoperative lobular compression, and scar ointments. Perivascular infiltration was noted in intra- and extra-keloid tissue in 70% of patients. The postoperative recurrence rate was 10%, and most of the patients satisfied with treatment outcomes. Conclusion: Histological perivascular inflammation is a prominent feature of lobular keloids. Proper surgical treatment, adjuvant treatments, and persistent follow-up observation were sufficient in maintaining a relatively low rates of recurrence.

• Archives of Plastic Surgery
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• v.50 no.6
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• pp.563-567
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• 2023

Ear keloids are challenging lesions to treat due to high recurrence rates postexcision. Conservative compression techniques as adjunct treatment have been reported to be effective. An innovative technique of using computer-aided design/computed-aided manufacturing to print a customized auricular splint improves efficiency and comfort level for patients compared with conventional methods. The ear is scanned using an intraoral scanning 2 weeks postsurgery. A two-piece auricular splint is designed on the digital model, incorporating perforated projections for three nylon screws for retention of the splint. The splint is printed with clear acrylic material, postprocessed, and finished. The patient is taught to assemble the components of the splint and instructed to wear for at least 8 hours daily. The surgery site reviewed for any ulceration, pain, or recurrence of keloid for 6 months. During the 6-month review, the excision scar remained flat and pink. The patient also reports unrestricted daily activities. The digital workflow increases comfort for the patient and reduces the number of hours required to produce a customized auricular splint compared with conventional methods. A fully digital workflow for a printed auricular splint should be considered for adjunctive treatment to excision of ear keloids.

• Archives of Plastic Surgery
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• v.42 no.5
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• pp.588-595
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• 2015

Background Radiotherapy treatment after keloidectomy is known to be an effective method for reducing the rate of recurrence. However, to date, the appropriate total radiation dose and fractionation have not yet been confirmed. The authors performed a retrospective analysis to identify the appropriate radiation dose and fractionation in post-keloidectomy radiotherapy. Methods From May 2000 to February 2011, postoperative radiotherapy was performed on 39 lesions in 28 patients after total keloidectomy. The keloid lesions were confined to the ear lobes. Between May 2000 and May 2004, 14 keloids were treated with surgical excision, followed by a total radiation dose of 1,200 cGy in three fractions over four to five days (group 1). Between June 2004 to February 2011, 25 keloids were treated with surgical excision, followed by a total radiation dose of 1,500 cGy in three fractions over four to five days (group 2). Patients were given a survey asking them to report their experiences regarding reoperation, recurrence of symptoms, recurrence of the lesion, and satisfaction with the operation. Results Of the 28 patients who were treated, 20 underwent follow-up. Group 2 had more cases showing elevation with erythematous changes, whereas group 1 had more cases showing progressive stages of elevation than group 2. These differences were statistically significant. Moreover, a correlation was observed between the level of keloid elevation and the extent of symptoms. Conclusions We suggest 1,500 cGy of radiation in three fractions following keloidectomy for ear lobe keloids. A further randomized study is needed to assess the recurrence of keloids after radiotherapy.

• Archives of Craniofacial Surgery
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• v.23 no.4
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• pp.190-191
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• 2022

• Archives of Plastic Surgery
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• v.36 no.1
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• pp.11-18
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• 2009

Purpose: Excessive scarring in the forms of keloid and hypertrophic scar could be a consquence of the accumulation of granulation tissue cells due to aberrant control of apoptosis. Verapamil retard extracelluar matrix production and inhibits VEGF production in primary cultured keloid fibroblast. The object of this study was effect of verapamil on VEGF expression and apoptosis in early wound scarring of the rabbit ear. Methods: Full thickness wounds were created on the ventral side of 6 New Zealand rabbits's ear. 16 days after initial wounding verapamil and saline were injected each scars and scars were harvested 1 week, 2 weeks, 4 weeks later. The wounds were stained with hematoxylin and eosin, TUNEL stain, immunohistochemical stain for VEGF and calculated scar elevation index. Results: Histologic analaysis demonstrated significant reduction in inflammation, vascularity and improvement in dermal collagen organization in experimental group. In TUNEL staining apotosis positive cells were increased and immunohistochemial staining of VEGF demonstrated significant reduction of VEGF expression in experimental group. No significant difference was noted in scar elevation index between two groups. Conclusion: This study suggest that intralesional injection of verapamil on early wound scarring of the rabbit ear decreased VEGF production and increased apoptosis and have a benefit on the pathophysiology of scar formation.

• Archives of Plastic Surgery
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• v.32 no.6
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• pp.717-722
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• 2005

The authors evaluated 14 patients from July 1999 to February 2004 treated with total keloidectomy followed by postoperative radiation treatment, delivered within 24 hours or 24-36 hours after surgery. The total dose of radiation was 1200 cGy in three fractions for 4-5 days. Among the 14 patients treated, 8 patients were evaluated for following-up. The age range of these patients were from 22 to 44 years old, with the average age of 30 years. The site of keloid lesions consisted; 6 on the ear lobe, 5 on the anterior chest and 1 on the upper arm. The mean follow-up period was 29.9 months. The recurrence was evaluated with photogrammetric analysis and skin color analysis. The photogrammetric analysis was performed with planimetry for the comparison of the ratio of the reduced size to the preoperative size. The mean value of the relative size of reduction was 55% and the ratio of the ear lobes were greater than the ratio of the chests. The skin color analysis was performed with chromameter CR-300 for the analysis of color difference (E) between the surrounding normal skin and the lesion. The larger the recurred size was, similar to the original size, the larger the E value was, so the E value posses the probability of predictable objective tool of recurrence. Although verifying the effectiveness of radiation therapy following keloidectomy need more cases and long term follow-up evaluation, this therapeutic modality seems very effective in reducing the keloid size, especially in the ear lobe.

• Radiation Oncology Journal
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• v.15 no.3
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• pp.269-276
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• 1997

Purpose : To evaluate the effects of surgical excision followed by radiation therapy for Prevention of keloids and hypertrophic scars. Materials and Methods : From October 1987 to April 1995, radiation therapy was applied to 167 sites in 106 patients with surgical excision in an attempt to prevention of recurrence against keloids and hypertrophic scars. The main etiology of the keloids and hypertrophic scars were surgery in $49.2\%,\;trauma\;in\;25.0\%,\;ear-piercing\;in\;5.4\%,\;and\;burn\;in\;5.4\%$, The Patients' ages ranged from 3 to 70 years with a median of 32 years. Radiation therapy used ranged from 6 to 8MeV electron beam. Radiation therapy was delivered within 24 hours of surgical excision. Several dose schedules were used, varing from 400cGy in 1 daily fraction to 1900cGy in 4 daily fractions. The average total dose was 1059cGy, and the average dose per fraction was 433cGy. All patients were followed up from 24 to 114 months with a median follow up of 49 months. Results : The overall recurrence rate was $12.6\%$ (21/167) The overall 1-year and 2-year recurrence rates were $10.2\%\;and\;11.4\%$, respectively Among 21 recurrent sites, seventeen sites $(81\%)$ were confirmed within 12 months after surgical excision. Period to recurrence ranged from 1 month to 47 months with a median recurrence time of 9.6 months, The history of previous therapy was only a significant factor in recurrence. Twenty-four patients had history of previous therapy recurrence rates was significantly higher in this group than those without history of Previous therapy $(22.6\%\;vs.\;11.0\%,\;p=0.04)$. There was no serious complication related to radiation therapy. Conclusion : This study suggests that surgical excision followed by radiation therapy is an effective method of preventing keloids and hypertrophic scars.