2017-18 HSC Section 4 Green Book

Volume 134, Number 3 • Treatment of Recalcitrant Keloids

at follow-up by the patient and an independent medical doctor using the Patient and Observer Scar Assessment Scale as a descriptive measure to record the postoperative scar. 13–15 Each item of this scale was scored using a 10-step score, in which 10 reflected “worst scar imaginable” and 1 indicated “normal skin,” amounting to a total pos- sible score of 60. 13–15 To calculate the overall score, all six items were added, amounting to a total pos- sible score of 60. In addition, the patients were questioned on seven predetermined parameters: pain, pruritus, movement induction, burning sen- sation, physical burden, functional discomfort, and dysesthesia. Statistical Analysis All statistical analyses were conducted using IBM SPSS Version 20.0 (IBM Corp., Armonk, N.Y.). Dependent t tests were performed to com- pare the visual analogue scale scores before and after treatment. Descriptive statistical analyses were used to assess outcomes. A value of p < 0.05 was consid- ered statistically significant. Characteristics Between 2003 and 2009, 43 patients with 67 keloids were treated. All patients started the study, but during follow-up some patients were untrace- able ( n = 8) or no longer willing to participate in the study ( n = 7). At long-term follow-up, a total of 28 patients with 35 keloids were analyzed, consti- tuting 65 percent of the initial 43 patients (Fig. 2). Table 1 lists the patient characteristics of the study group. The mean age of the patients was 36.3 years (range, 18 to 68 years), 66 percent were female patients, and 34 percent were male patients; 34.3 percent of the patients were Caucasian (Fitzpat- rick I to II), 14.3 percent had Mediterranean/ Asian skin color (Fitzpatrick III to IV), and 51.3 percent were African American (Fitzpatrick V to VI). The mean age of the scars was 6 years (range, 2 to 21 years), and all scars had proven recalci- trant to other treatments, but none had received prior radiation therapy. Thirty-seven percent of the keloids were located on the ear lobules and 20 percent were located on the sternum. Radiation Protocol Three patients did not complete the radiation protocol (Fig. 2). Two of these three patients had an overnight dislocation of the catheter; one of RESULTS

keloid location was identified using a well-docu- mented photographic archive and precise wound descriptions. The residual scar was examined, photographs were taken, and surface area was measured. The recurrence rate was used as the primary outcome and was defined as a growing, pruritic, nodular scar as described by Cosman and Wolff. 20 Subjective scar evaluation was performed Fig. 1. Surgical procedure. The keloid ( above ) was excised extra­ lesionally ( center ) and a catheter was positioned between the dermal edges of the wound, 5 mm below the surface of the skin and extending out of the skin beyond the wound ( below ). The catheter followed the shape of the scar, and was kept intact without kinking. Postoperatively, patients were transferred immediately to the radiation department.

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