Our Summary

This research paper discusses a potential treatment strategy for upper-arm keloids, which are raised scars that form where the skin has healed after an injury. The study was conducted on patients who had received a particular type of vaccine and then developed a keloid at the site of the injection.

The treatment involved removing the keloid surgically, then using a specific type of stitching technique (multiple z-plasties) to reduce tension on the wound and help it heal better. After the surgery, patients were given a type of radiotherapy (18 Gy/3 fractions/3 days) and then had to manage their wound with silicone tape and, if necessary, steroid plaster.

The study followed patients for two years to see if the keloid came back. The keloid was considered to have returned if a stiff, red lesion appeared on any part of the scar, and it didn’t get better after at least two months of treatment with the steroid plaster.

Out of 38 patients in the study, only two had their keloids return, and these were successfully treated with steroid plaster and steroid injections. The patients whose keloids came back were more likely to have multiple keloids on their bodies, but the size of the original keloid didn’t make a difference.

The researchers concluded that this combination of surgery, radiotherapy, and post-operative care could be a successful way to treat upper-arm keloids.

FAQs

  1. What is the treatment strategy discussed in the research paper for upper-arm keloids?
  2. What was the follow-up period of the study and how was the return of a keloid identified?
  3. What are the factors that may increase the likelihood of keloids returning after treatment?

Doctor’s Tip

A doctor might advise a patient undergoing z-plasty for keloid treatment to follow post-operative care instructions carefully, including using silicone tape and steroid plaster as directed. It is important to monitor the scar for any signs of recurrence, such as stiffness and redness, and to seek medical attention if these occur. Additionally, patients with multiple keloids may require additional monitoring and treatment to prevent recurrence.

Suitable For

Patients who are typically recommended for z-plasty include those with:

  1. Keloids or hypertrophic scars that are causing functional or cosmetic issues
  2. Scars that are under tension and at risk of becoming wider or more prominent
  3. Patients who have already tried other treatments for their scars without success
  4. Patients who are medically stable and able to undergo surgery and post-operative care

It is important for patients to discuss their individual case with a healthcare provider to determine if z-plasty is the best treatment option for them.

Timeline

  • Before z-plasty: The patient would have had a keloid at the site of an injection, likely causing discomfort and cosmetic concerns. They may have tried other treatments without success before considering surgery.
  • During z-plasty: The patient would undergo surgical removal of the keloid, followed by the z-plasty technique to reduce tension on the wound and improve healing. They would then receive radiotherapy and be instructed on wound management post-operatively.
  • After z-plasty: The patient would be monitored for two years to see if the keloid returns. If it does, additional treatments such as steroid plaster and injections may be necessary. Overall, the study showed that this treatment approach was successful in most cases for treating upper-arm keloids.

What to Ask Your Doctor

  1. What is a z-plasty and how does it help reduce tension on the wound?
  2. What are the potential risks or complications associated with z-plasty surgery for keloids?
  3. How long is the recovery process after z-plasty surgery for keloids?
  4. How effective is radiotherapy in preventing keloid recurrence after surgery?
  5. What post-operative care measures are necessary to optimize the results of z-plasty surgery for keloids?
  6. Are there any alternative treatment options for keloids that should be considered?
  7. How frequently should follow-up appointments be scheduled after z-plasty surgery for keloids?
  8. Can you provide more information on the success rate of z-plasty surgery for upper-arm keloids based on your experience?

Reference

Authors: Dohi T, Kuribayashi S, Tosa M, Aoki M, Akaishi S, Ogawa R. Journal: Plast Reconstr Surg Glob Open. 2019 Nov 27;7(11):e2496. doi: 10.1097/GOX.0000000000002496. eCollection 2019 Nov. PMID: 31942294