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• W2883647686 abstract "INTRODUCTION:Plastic Surgery is an ocean. One life time is notenough to unravel its deepest secrets.Perhaps no other problem in Plastic Surgery is so aptly described bythis statement as that of the keloid.Keloids form as a result of abnormal growth of scar tissue usuallyafter trivial injury to the skin. The cause, the inciting factors, itspredisposition to occur in certain races, certain injuries and certain sites arestill to be explained. Moreover, the phenomenon is peculiar to humansalone.It is a source of distress to the patient, as even though it is notmalignant, it grows to enormous proportions and is not only a cosmeticdeformity but also produces itching, burning pain and bleeding.Treatment is a frustrating experience for surgeons, as keloids have amarked propensity to recur after excision, the recurrence rate being as highas 45% to 100%. Therefore several other modalities of treatment have beentried either alone or in combination with surgery. They include intralesionalsteroid injections, pressure garments, silicone gel sheet application andvarious drugs but not with any significant success in rates of control.AIM OF THE STUDY:The current study was evolved to test the hypothesis that Surgeryfollowed by HDR Brachytherapy was an effective method of treatingkeloids.This study also analysis:● The age and sex of patients with keloids.● The common sites of occurrence.● The causes for developing keloids.● The clinical signs and symptoms of these patients.● The method of surgery plus radiotherapy employed.● The immediate follow up and condition at one year.● The incidence of complications and recurrence of keloid.PATIENTS & METHODS:This study was carried out in the Departments of Plastic andReconstructive Surgery, Kilpauk Medical College and GovernmentRoyapettah Hospital and in the Department of Radiation Oncology,Government General Hospital and Dr. Rai Memorial Hospital.The period of study was from June 2004 to January 2006.Patients seeking treatment for keloids and attending the Out PatientDepartments of Plastic Surgery were candidates for the study. Most patientshad keloids that were at high risk for relapse because they had beenpreviously excised and had recurred. The patients were chosen at randomand the study group consisted of 15 patients. Keloidal scars of any duration,any etiology and any site were enrolled into the study. The only patientsexcluded were children below twelve years of age.A patient proforma was filled up detailing the history (duration, site,etiology, symptoms, previous treatment history and family history); theclinical features (site, size, surrounding skin, similar lesions elsewhere,ulcers, infection, appearance and quality of skin).An informed consent was obtained from the patient. The treatmentplan, the advantages and problems of the procedure, the necessity ofstringent follow-up were explained. The other treatment options availablewere also highlighted.The keloid was then excised extralesionally except in a few largeearlobe / helical keloids where intralesional excision preserved availablenormal skin, under local or general anaesthesia as the case required. Thewound was closed primarily without tension in one or two layers of nonabsorbable simple sutures, after securing complete hemostasis.OBSERVATION:● 15 patients in this study included 13 women and 2 men making a male:female ratio of 1 : 6.5.● The age range of the patients:Age 13 - 20 yrs = 5, 21 - 30 yrs = 5, 31 - 40 yrs = 4, >40 yrs = 1,● The duration of the keloids in these patients ranged between 6months to 18 years.● The ear was the most common site of involvement seen in 11 out of 15cases. In five cases, the helix (site of secondary ear boring) and in 6 casesthe ear lobe had keloids.● In 5 cases, both the anterior and posterior surfaces of the ear wereinvolved.● 4 patients had bilateral involvement. In such cases, both sides wereoperated but only one side was irradiated. The other side therefore acts asa control.The sites that were found in this series are :Ear - 11,Chest - 1,Neck - 1,Shoulder - 1,Face - 1.● Trauma and infection were found to be the most common incitingfactors. Trauma ranged from minor injury due to nail scratch tosignificant trauma like a cut with a sunmica sheet or surgery.● All patients requested treatment because of the unsightly nature of thekeloid. 6 patients also complained of occasional itching and4 patients of a dull pain exacerbated by accidental trauma to the lesion.CONCLUSION:● Keloids are a vexing problem for patients and plastic surgeons.● Once they occur, a single modality treatment is fraught with recurrence.● Post excisional radiotherapy affords good control, but with thedisadvantage of radiation to normal tissues.● HDR Brachytherapy offers an ideal solution as -Can be done in an out patient basisRelatively low costExcellent radiation protectionBetter dose distribution to tissues.● With a local control rate of 93% and no significant side effects, HDRBrachytherapy following surgery is an effective treatment of keloid scar." @default.
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• W2883647686 date "2006-08-01" @default.
• W2883647686 modified "2023-09-26" @default.
• W2883647686 title "Treatment of Keloids With Surgery and Post-Operative Brachytherapy" @default.
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