I. Change of medication and removal of stitches You must go to the radiotherapy department the day after the removal of the keloid for the first electron beam irradiation. The second electron beam irradiation is scheduled for about a week afterwards (the radiotherapy department will inform the next radiation treatment after the first one, if not, please remind the radiologist). You have to come back the same day after the first E-ray irradiation to change the medication. If you don’t have your radiation treatment before 4:00 pm, please contact your assistant doctor to confirm that you will have your medication changed by the doctor on duty in the evening. Please follow the instructions on the medication change sheet and complete the medication change and removal of stitches on time. For non-special sites, the stitches are usually removed on the 8th-10th postoperative day. If you want to have electronic wire irradiation on the day of stitches removal, you can come to the hospital to remove the stitches before going to the radiotherapy department for irradiation. After the removal of the stitches, if the crust is not very heavy, you can wash your face and shower the next day to resume normal life (the operated area can also be exposed to water).
Radioactive dermatitis In the first month after surgery, radioactive dermatitis may appear in the irradiated area. The occurrence of radiation dermatitis is related to the patient’s own constitution, only a few people will occur, especially second degree radiation dermatitis is rare. Radiation dermatitis is not terrible and the majority of people can heal on their own. To prevent radiation dermatitis, it is recommended to start applying vitamin E cream twice a day for a month early after the stitches are removed. The application is applied to the irradiated area, usually in a boxed area one to two centimeters larger around the incision.
First-degree radiation dermatitis is similar to the process of changes in the skin caused by sunburn from too much sun exposure. The skin at the irradiated area will appear mildly red and swollen, and the patient will feel burning, itchy, and hot. After a few days the irradiated skin will break out and the burning pain and itching will then disappear. This process usually lasts about a week. After the skin bursts, the skin color first turns white and then gradually “darkens”, commonly known as tanning, and it takes more than 1 year to fade back to its original color. The first degree of radioactive dermatitis, if there is no particularly serious problems can continue to smear vitamin E cream. Be careful not to scratch your hands because of itching, scratching the skin will aggravate the skin damage or cause infection. If the patient’s symptoms are particularly severe, he or she can go to the dermatology department of the local tertiary care hospital.
In second degree radiation dermatitis, the skin will blister, or it may be a large blister, which is better identified. There is another kind, small blisters like pinpoints, densely packed. If they break, they will be watery. If second-degree radiation dermatitis occurs, go to the dermatology department of a tertiary care hospital for prompt treatment. The second degree of radiation dermatitis will usually heal itself in a month, and if treated in time, this time will be significantly shortened.
The pathogenesis of keloid scarring is not clear so far, so it is not possible to achieve absolute 100% cure, and there is a possibility of recurrence after surgery. Even with surgical excision combined with electron beam irradiation, the cure rate is only 90%, and 10% of patients still have recurrence. If there are signs of recurrence, be sure to come back in time for a review. Recurrence, which starts from a small point, will continue to grow if not intervened and will make treatment difficult. Therefore, it is important to review regularly one month, three months, six months, twelve months, and twenty-four months after surgery to detect and intervene in time. If you suspect a recurrence in the interval between reviews, please feel free to seek medical attention. If a recurrence occurs after keloid surgery, there is no need to be overly concerned. Early intervention can be done with medication or reoperation after one year for repair.
To prevent recurrence, do not drink alcohol, eat chili peppers, and eat a little less beef and lamb for two years after surgery.
In the case of chest keloid, be careful not to do exercises that pull the chest (including swimming, weight lifting, yoga, etc.), such as tilting the head back and lifting the chest, to avoid pulling the incision on the chest and increasing the probability of recurrence of the keloid.