Objectives: Share and discuss own experience in surgical excision followed by immediate cryosurgery for the treatment of keloids. Discussion of indications, alternative modalities
Introduction: Keloid scars result from an abnormal healing response either after injury of the skin or spontaneously. The high recurrence rate after treatment is challenging as well as psychological impact. Keloid formation results from aberrant dermal fibroblast activity, exacerbated by exogenous inflammatory and wound healing signals. Cryosurgery (CS) is one of the treatment options. It modulates fibroblasts proliferation, avoiding loss of the swirl structure of collagen bundles, resulting in a harmonious reorganization of collagen fibres. Moreover, CS reduces VEGF and TGF expression.
Materials / method: Several techniques of CS have been proposed. Contact CS often required numerous sessions to obtain consistent results. Intralesionnal CS is proposed especially in case of large, bulky and recalcitrant keloids for which previous excision is not possible. We will present our experience, using combination of surgical excision and immediate CS. This technique is particularly useful for earlobe keloids or post-otoplasty keloids. We will also described how a close follow-up (every 2 months for 2 years) is important to avoid recurrences.
Results: We perform treatment under local anaesthesia, combined with initial nitrous oxide inhalation. Complete excision of the keloid is suitable and is possible in main cases. After electrocoagulation, the open wound is immediately frozen with a contact probe adapted to the size of the wound. Depending on the size of the keloid successive freezing impacts are needed. The CS is controlled by an impedance meter until 800 to 1000 Kohms (about 30 seconds) allowing a halo of freezing of 3 mm. is applied on the open wound. Daily removal of dressing is proposed and paraffin tulle may be used after 1 week.
Conclusion: With this procedure, we obtain in a unique session quite good results for a majority of patients, with a good tolerance, notably no cartilage was observed in our practice. Again we want to underline the importance of a close follow-up of the patients.
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