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Surgery and Radiation Therapy for Keloids and Hypertrophic Scars

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Total Scar Management
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Abstract

Over the past 10 years, our understanding of the pathogenesis of pathological scars, including keloids and hypertrophic scars, has increased markedly. Consequently, keloids and hypertrophic scars are now regarded as treatable diseases. However, the available therapeutic approaches still require improvement. Surgery and radiation therapy should play more prominent roles in current therapeutic strategies for pathological scars. Due to fear of recurrence after keloid resection (which often led to even worse scars), plastic surgeons and dermatologists have been fearful about actively treating keloids. However, there is substantial evidence now that surgery followed by radiation therapy can successfully manage keloids and hypertrophic scars with low levels of recurrence. The development of a standard international algorithm for treating pathological scars on the basis of this evidence is warranted. This chapter discusses the reasons for this. Optimal surgical and radiotherapy treatment protocols and the possible side effects of radiotherapy are also discussed.

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References

  1. Huang C, Murphy GF, Akaishi S, Ogawa R. Keloids and hypertrophic scars: update and future directions. Plast Reconstr Surg Glob Open. 2013;1(4):e25.

    Article  PubMed  PubMed Central  Google Scholar 

  2. Ogawa R. Keloid and hypertrophic scars are the result of chronic inflammation in the reticular dermis. Int J Mol Sci. 2017;18(3):E606.

    Article  PubMed  Google Scholar 

  3. Ogawa R, Akaishi S, Kuribayashi S, Miyashita T. Keloids and hypertrophic scars can now be cured completely: recent progress in our understanding of the pathogenesis of keloids and hypertrophic scars and the most promising current therapeutic strategy. J Nippon Med Sch. 2016;83(2):46–53.

    Article  CAS  PubMed  Google Scholar 

  4. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids. Plast Reconstr Surg. 2010;125(2):557–68.

    Article  CAS  PubMed  Google Scholar 

  5. Ogawa R, Akaishi S. Endothelial dysfunction may play a key role in keloid and hypertrophic scar pathogenesis—keloids and hypertrophic scars may be vascular disorders. Med Hypotheses. 2016;96:51–60.

    Article  CAS  PubMed  Google Scholar 

  6. Ogawa R. Mechanobiology of scarring. Wound Repair Regen. 2011;19(Suppl 1):s2–9.

    Article  PubMed  Google Scholar 

  7. Mandy SH. The practical use of Z-plasty. J Dermatol Surg. 1975;1(4):57–60.

    Article  CAS  PubMed  Google Scholar 

  8. Ogawa R, Akaishi S, Huang C, Dohi T, Aoki M, Omori Y, Koike S, Kobe K, Akimoto M, Hyakusoku H. Clinical applications of basic research that shows reducing skin tension could prevent and treat abnormal scarring: the importance of fascial/subcutaneous tensile reduction sutures and flap surgery for keloid and hypertrophic scar reconstruction. J Nihon Med Sch. 2011;78(2):68–76.

    Article  Google Scholar 

  9. Yoshino Y, Kubomura K, Ueda H, Tsuge T, Ogawa R. Extension of flaps associated with burn scar reconstruction: a key difference between island and skin-pedicled flaps. Burns. 2018;44:683–91.

    Article  PubMed  Google Scholar 

  10. Jacobsson F. The treatment of keloids at Radium-hemmet, 1921–1941. Acta Radiol. 1948;29(3):251–67.

    Article  CAS  PubMed  Google Scholar 

  11. Levy DS, Salter MM, Roth RE. Postoperative irradiation in the prevention of keloids. AJR Am J Roentgenol. 1976;127(3):509–10.

    Article  CAS  PubMed  Google Scholar 

  12. Enhamre A, Hammar H. Keloids with excision and postoperative X-ray irradiation. Dermatologica. 1983;167(2):90–3.

    Article  CAS  PubMed  Google Scholar 

  13. Borok TL, Bray M, Sinclair I, Plafker J, LaBirth L, Rollins C. Role of ionizing irradiation for 393 keloids. Int J Radiat Oncol Biol Phys. 1988;15(4):865–70.

    Article  CAS  PubMed  Google Scholar 

  14. Kovalic JJ, Perez CA. Radiation therapy following keloidectomy: a 20-year experience. Int J Radiat Oncol Biol Phys. 1989;17(1):77–80.

    Article  CAS  PubMed  Google Scholar 

  15. Doornbos JF, Stoffel TJ, Hass AC, Hussey DH, Vigliotti AP, Wen BC, Zahra MK, Sundeen V. The role of kilovoltage irradiation in the treatment of keloids. Int J Radiat Oncol Biol Phys. 1990;18(4):833–9.

    Article  CAS  PubMed  Google Scholar 

  16. Chaudhry MR, Akhtar S, Duvalsaint F, Garner L, Lucente FE. Ear lobe keloids, surgical excision followed by radiation therapy: a 10-year experience. Ear Nose Throat J. 1994;73(10):779–81.

    Article  CAS  PubMed  Google Scholar 

  17. Norris JE. Superficial X-ray therapy in keloid management: a retrospective study of 24 cases and literature review. Plast Reconstr Surg. 1995;95(6):1051–5.

    Article  CAS  PubMed  Google Scholar 

  18. Sclafani AP, Gordon L, Chadha M, Romo T 3rd. Prevention of earlobe keloid recurrence with postoperative corticosteroid injections versus radiation therapy: a randomized, prospective study and review of the literature. Dermatol Surg. 1996;22(6):569–74.

    Article  CAS  PubMed  Google Scholar 

  19. Ragoowansi R, Cornes PG, Glees JP, Powell BW, Moss AL. Ear-lobe keloids: treatment by a protocol of surgical excision and immediate postoperative adjuvant radiotherapy. Br J Plast Surg. 2001;54(6):504–8.

    Article  CAS  PubMed  Google Scholar 

  20. Malaker K, Vijayraghavan K, Hodson I, Al Yafi T. Retrospective analysis of treatment of unresectable keloids with primary radiation over 25 years. Clin Oncol (R Coll Radiol). 2004;16(4):290–8.

    Article  CAS  Google Scholar 

  21. Klumpar DI, Murray JC, Anscher M. Keloids treated with excision followed by radiation therapy. J Am Acad Dermatol. 1994;31(2 Pt 1):225–31.

    Article  CAS  PubMed  Google Scholar 

  22. Caccialanza M, Piccinno R, Schiera A. Postoperative radiotherapy of keloids: a twenty-year experience. Eur J Dermatol. 2002;12(1):58–62.

    PubMed  Google Scholar 

  23. Speranza G, Sultanem K, Muanza T. Descriptive study of patients receiving excision and radiotherapy for keloids. Int J Radiat Oncol Biol Phys. 2008;71(5):1465–9.

    Article  PubMed  Google Scholar 

  24. Lo TC, Seckel BR, Salzman FA, Wright KA. Single-dose electron beam irradiation in treatment and prevention of keloids and hypertrophic scars. Radiother Oncol. 1990;19(3):267–72.

    Article  CAS  PubMed  Google Scholar 

  25. Chen HC, Ou SY, Lai YL. Combined surgery and irradiation for treatment of hypertrophic scars and keloids. Zhonghua Yi Xue Za Zhi (Taipei). 1991;47(4):249–5.

    CAS  Google Scholar 

  26. Maarouf M, Schleicher U, Schmachtenberg A, Ammon J. Radiotherapy in the management of keloids. Clinical experience with electron beam irradiation and comparison with X-ray therapy. Strahlenther Onkol. 2002;178(6):330–5.

    Article  PubMed  Google Scholar 

  27. Bischof M, Krempien R, Debus J, Treiber M. Postoperative electron beam radiotherapy for keloids: objective findings and patient satisfaction in self-assessment. Int J Dermatol. 2007;46(9):971–5.

    Article  PubMed  Google Scholar 

  28. Ogawa R, Mitsuhashi K, Hyakusoku H, Miyashita T. Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months. Plast Reconstr Surg. 2003;111(2):547–53. discussion 554–5.

    PubMed  Google Scholar 

  29. Ogawa R, Miyashita T, Hyakusoku H, Akaishi S, Kuribayashi S, Tateno A. Postoperative radiation protocol for keloids and hypertrophic scars: statistical analysis of 370 sites followed for over 18 months. Ann Plast Surg. 2007;59(6):688–91.

    Article  CAS  PubMed  Google Scholar 

  30. Vivante H, Salgueiro MJ, Ughetti R, Nicolini J, Zubillaga M. 32P-patch contact brachyradiotherapy in the management of recalcitrant keloids and hypertrophic scars. Indian J Dermatol Venereol Leprol. 2007;73(5):336–9.

    Article  CAS  PubMed  Google Scholar 

  31. Supe SS, Supe SJ, Rao SM, Deka AC, Deka BC. Treatment of keloids by 90Sr-90Y beta-rays. Strahlenther Onkol. 1991;167(7):397–402.

    CAS  PubMed  Google Scholar 

  32. Fraunholz IB, Gerstenhauer A, Böttcher HD. Results of postoperative (90)Sr radiotherapy of keloids in view of patients’ subjective assessment. Strahlenther Onkol. 2005;181(11):724–9.

    Article  PubMed  Google Scholar 

  33. Malaker K, Zaidi M, Franka MR. Treatment of earlobe keloids using the cobalt 60 teletherapy unit. Ann Plast Surg. 2004;52(6):602–4.

    Article  PubMed  Google Scholar 

  34. Malaker A, Ellis F, Paine CH. Keloid scars: a new method of treatment combining surgery with interstitial radiotherapy. Clin Radiol. 1976;27(2):179–83.

    Article  CAS  PubMed  Google Scholar 

  35. Escarmant P, Zimmermann S, Amar A, Ratoanina JL, Moris A, Azaloux H, Francois H, Gosserez O, Michel M, G’Baguidi R. The treatment of 783 keloid scars by iridium 192 interstitial irradiation after surgical excision. Int J Radiat Oncol Biol Phys. 1993;26(2):245–51.

    Article  CAS  PubMed  Google Scholar 

  36. Clavere P, Bedane C, Bonnetblanc JM, Bonnafoux-Clavere A, Rousseau J. Postoperative interstitial radiotherapy of keloids by iridium 192: a retrospective study of 46 treated scars. Dermatology. 1997;195(4):349–52.

    Article  CAS  PubMed  Google Scholar 

  37. Guix B, Henríquez I, Andrés A, Finestres F, Tello JI, Martínez A. Treatment of keloids by high-dose-rate brachytherapy: a seven-year study. Int J Radiat Oncol Biol Phys. 2001;50(1):167–72.

    Article  CAS  PubMed  Google Scholar 

  38. Garg MK, Weiss P, Sharma AK, Gorla GR, Jaggernauth W, Yaparpalvi R, Delrowe J, Beitler JJ. Adjuvant high dose rate brachytherapy (Ir-192) in the management of keloids which have recurred after surgical excision and external radiation. Radiother Oncol. 2004;73(2):233–6.

    Article  PubMed  Google Scholar 

  39. Narkwong L, Thirakhupt P. Postoperative radiotherapy with high dose rate iridium 192 mould for prevention of earlobe keloids. J Med Assoc Thai. 2006;89(4):428–33.

    PubMed  Google Scholar 

  40. Veen RE, Kal HB. Postoperative high-dose-rate brachytherapy in the prevention of keloids. Int J Radiat Oncol Biol Phys. 2007;69(4):1205–8.

    Article  PubMed  Google Scholar 

  41. Kuribayashi S, Miyashita T, Ozawa Y, Iwano M, Ogawa R, Akaishi S, Dohi T, Hyakusoku H, Kumita S. Post-keloidectomy irradiation using high-dose-rate superficial brachytherapy. J Radiat Res. 2011;52(3):365–8.

    Article  PubMed  Google Scholar 

  42. Ogawa R, Huang C, Akaishi S, Dohi T, Sugimoto A, Kuribayashi S, Miyashita T, Hyakusoku H. Analysis of surgical treatments for earlobe keloids: analysis of 174 lesions in 145 patients. Plast Reconstr Surg. 2013;132(5):818e–25e.

    Article  CAS  PubMed  Google Scholar 

  43. Ogawa R, Akaishi S, Dohi T, Kuribayashi S, Miyashita T, Hyakusoku H. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method. Plast Reconstr Surg. 2015;135(3):868–75.

    Article  CAS  PubMed  Google Scholar 

  44. Ogawa R, Ono S, Akaishi S, Dohi T, Iimura T, Nakao J. Reconstruction after anterior chest wall keloid resection using internal mammary artery perforator propeller flaps. Plast Reconstr Surg Glob Open. 2016;4(9):e1049.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Kal HB, Veen RE. Biologically effective doses of postoperative radiotherapy in the prevention of keloids. Dose-effect relationship. Strahlenther Onkol. 2005;181:717–23.

    Article  PubMed  Google Scholar 

  46. Preston DL, Ron E, Tokuoka S, Funamoto S, Nishi N, Soda M, Mabuchi K, Kodama K. Solid cancer incidence in atomic bomb survivors: 1958–1998. Radiat Res. 2007;168(1):1–64.

    Article  CAS  PubMed  Google Scholar 

  47. Ogawa R, Yoshitatsu S, Yoshida K, Miyashita T. Is radiation therapy for keloids acceptable? The risk of radiation-induced carcinogenesis. Plast Reconstr Surg. 2009;124(4):1196–201.

    Article  CAS  PubMed  Google Scholar 

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Ogawa, R. (2020). Surgery and Radiation Therapy for Keloids and Hypertrophic Scars. In: Ogawa, R. (eds) Total Scar Management. Springer, Singapore. https://doi.org/10.1007/978-981-32-9791-3_11

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  • DOI: https://doi.org/10.1007/978-981-32-9791-3_11

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