Efficacy of triple therapy in auricular keloids.

BACKGROUND: Keloids are characterised by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Auricular 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 clips and cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of the three-dimensional structure of the ear following resection is a challenge to the cutaneous surgeon. OBJECTIVES: To devise a standard protocol for management of auricular keloids with minimal distortion and recurrence. SETTING AND DESIGN: The patients underwent day-care surgery and subsequent out-patient follow-up for a minimum period of 1 year. METHODS: Ten patients presenting with 22 ear keloids were enrolled into a keloid protocol: (a) surgical excision and keloid rind flap cover with (b) intra-operative and post-operative intra-lesional steroid and (c) silicone sheet application. Subjective assessment on follow-up was using Patient Observer Scar Assessment Scale and objective assessment was by Beausang scale. STATISTICAL ANALYSIS USED: Microsoft Excel and Statistical Package for the Social Sciences (SPSS). Kaplan-Meier survival analysis curve used to calculate Recurrence Free period. RESULTS: Two out of 22 (9.1%) keloids developed post-excision recurrence after a mean follow -up period of 16 months. The average keloid recurrence free interval was 21 months. CONCLUSION: Triple combination therapy for keloids on the ear is a simple technique for management with preservation of contour of the ear and a low recurrence rate.

Tissue expansion: A simple technique for complex traumatic soft tissue defects.

Post-traumatic soft tissue loss results in significant functional and esthetic morbidity. Reconstruction is often limited by shortage of soft tissues. Esthetic and functional restorations are possible by generation of well-matched autogenous sensate tissue by tissue expansion. Fifteen (nine females and six males) cases of large and complex soft tissue defects after trauma, age ranging from 7 to 43 years of age, were managed by tissue expansion over a period of 22 months. Indications were post-burn scars of the face (five), post-burn alopecia (three), avulsion injury scalp (one), massive abdominal wall defect (one), post-crush injury ankylosis of the right elbow (one), and post-burn contracture of the neck (three). Tissue expansion was well tolerated by all patients. Major complications seen were accidental implant deflation (6.6%) and partial implant exposure (6.6%). Minor complications were seen in 20% of the cases. Tissue expansion is slow and staged but a simple and safe reconstructive technique for managing large post-traumatic soft tissue loss with excellent results.