Surgical Treatment of Keloids in the Ear: Prospective and Randomized Study Comparing Direct Surgical Excision vs. Keloid Fillet Flap

Abstract

Introduction: Keloids and hypertrophic scars are characterized by abnormal responses to the healing process and involve intense production and deposition of collagen and glycoproteins in the dermis, resulting in the development of a pathological scar. To compare the techniques for keloid resection preserving the epidermis and superficial dermis, Keloid Fillet Flap (KFF), with direct surgical excision treatment for resecting all the scars with primary closure. Methods: The design of the study was a prospective and randomized study in a single-center with patients who had keloids in the auricular area. All of the participant patients were randomly divided into two groups: direct surgical excision-RC (n = 36 patients); and the group Keloid Fillet Flap-KFF (n = 37 patients). In both groups, neoadjuvant treatment of infiltration with triamcinolone 20 mg/ml until the end of the clinical activity of the keloid was performed, and the treatments were followed by the adjuvant treatment of 10 sessions of Beta Ray Therapy. Results: The present study enrolled 73 patients, of which 37 comprised the KFF group and 36 the RC group. Following the use of the scar measuring scales to define the recurrence rate, our study demonstrated a recurrence rate of the total sample of 62%, with the KFF group presenting a rate of 76% and the RC group presenting a rate of 40%. In the KFF group, the mean volume of the recurrent lesions was 56 cm3, versus 13.25 cm3 in those that did not recur. In the RC group, the mean volume was 57 cm3 in the recurrent lesions and 1.6 cm3 in the non-recurrent lesions. These volumetric differences were statistically significant (p 0.05), that is, the volume of relapses is much higher than that of non-relapsed ones.