Outcome of Keloid's Treatment in a Tertiary Care Hospital

Abstract

Introduction: Keloids are characterized by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Keloids are common following ear piercing or flame burns. These lesions are highly conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, antimitotic agents, silicone sheet, pressure clipsand cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of following resection is a challenge to the surgeon.

Material and Methods: A total of 46 patients with keloid were treated at the plastic surgery department of the Nepalgunj Medical College between January 2013 to March 2017. The patients were divided in two groups. Group A consisted of 24patients with keloid in their ear where complete excision of keloid was done with tension free repair and was supplemented withintralesion triamcinolone injection at the time of operation and thereafter as and when needed. Group B consisted of 22 patients. Out of these 15 patients had keloid over the anterior chest wall and rest 07 had keloid over the deltoid region. These cases receivedintralesional triamcinolone only, a total of 5 such injections at month interval as a tension free repair after excision was notconsidered feasible.

Results & Conclusion: Patients in Group A underwent surgical excision and intra and post operative intralesionalsteroids and patients in Group B received 4 weekly intraregional injection of triamcinolone injection 40 mg. Out of 24 keloid in Group A two developed post-excision recurrence during a mean follow-up period of 24 months. However they regressed with subsequent local injection of steroid. The group B consisting of scar over the deltoid region and anterior chest wall were not found suitable for excision as a tension free repair (a must to prevent recurrence) was not considered possible. Complete Excision of keloids with tension free suture and local steroid injection is a simple & favored technique for the management of keloid, it preserves contour &skin quality and has a low recurrence rate. Unfortunately all cases are not suitable for total surgical excision. In such cases, steroid locally has to given locally at monthly intervals. The keloids regresses, but atrophy and depigmentation at the site of injection are the complications.