There are many surgical treatments for earlobe keloids. Smaller lesions can be closed by excision followed by direct suturing of the wound. However, many keloids are clinically larger lesions, and direct suturing after excision will result in excessive tension on the wound or changes in the shape of the ear. Faced with this difficult problem, some scholars have proposed skin grafting treatment, which involves replanting the scar skin of the excised keloid or trimming normal skin from other areas into medium-thickness skin grafts, but this method can cause a color mismatch between the grafted skin and the auricle.
Some scholars have also proposed the use of local flaps for wound coverage, which can repair the wound better but the additional incisions increase the chance of keloid occurrence. The principle of keloid flap repair that we use is to view the keloid as dilated skin wrapped around a hard keloid core, thus the area of the keloid flap formed by peeling is sufficient to repair the trauma, and the trauma can be well repaired by trimming according to the principles of local flap and ensuring the blood supply of the keloid flap. This method is an intra-scar excision of the keloid, and even if a recurrence of the keloid occurs, it will not exceed the original size.
Surgical excision of the ear keloid alone, whether by scalpel or laser cutting, has a recurrence rate of over 45% and thus requires the effective cooperation of other methods. The methods commonly used today are topical hormone injections, radiation therapy, topical application of silicone membranes, and compression therapy. Steroid injection is associated with skin atrophy, depigmentation, capillary dilation, necrosis, ulceration and other related adverse reactions; radiation therapy is difficult to control the radiation dose, easy to induce radiation dermatitis, or cause the risk of environmental pollution; silicone film, although safe to use, but the main application of the problem is not aesthetic and not easy to fix. Compression therapy has gradually become the main complementary method of surgical treatment because it is simple, safe and effective. Traditional compression therapy devices mainly use elastic wires to maintain pressure or apply small splints to apply pressure through screws; the main shortcomings are that they are not easy to wear and have poor aesthetics, thus making it difficult for patients to check and wear them for a long time.
We use magnet sheet earrings, which have significant advantages: simple structure, easy to wear, beautiful appearance, and cheap price. If pain occurs while wearing them during treatment, treatment can be continued by lining them with a silicone film and then completing the treatment.
The compression therapy method has been used for many years for the early prevention and treatment of pathological scarring and has also achieved positive clinical results. It is generally accepted that compression therapy should be started as early as possible after wound superficialization is complete, and although there are no large-scale clinical trials, the current study recommends starting compression therapy on the earlobe 2 weeks after stitch removal.
The intensity of pressure maintenance is very important; smaller pressures do not achieve therapeutic results, and larger pressures tend to cause ischemic damage to local tissues. It is generally considered that the pressure should be maintained at 1.33-3.3kpa, which is the pressure at which the capillaries close without affecting the peripheral blood circulation. Compression therapy is recommended to be maintained for more than 8h per day for more than six months of continuous use.
The exact mechanism is still unclear, but it is generally believed that: 1. Pressure causes a decrease in local tissue blood flow and a consequent decrease in α2 myosin, an inhibitor of collagenase, which enhances collagenase activity and accelerates collagen breakdown, leading to spiral collagen rearrangement and softening of the scar.
2. Pressure causes increased damage to the vessel wall, resulting in tissue ischemia, increased partial pressure of tissue carbon dioxide and decreased partial pressure of oxygen. In hypoxic condition, the partial pressure of intracellular oxygen decreases and the function of mitochondria decreases, while morphological changes occur, resulting in the inability of mitochondria to release energy during oxidative phosphorylation, resulting in the inhibition of fibroblast proliferation and finally degenerative necrosis, which reduces the ability to generate collagen fibers and matrix, thus leading to scar thinning and softening. Since a magnet sheet was used in this study, although the magnetic field can improve the properties of the scar, its exact therapeutic mechanism needs to be further investigated.
We used a scar flap surgical treatment protocol with magnet sheet pressure treatment according to the characteristics of the ear keloid, which does not increase the patient’s pain and economic burden, is in accordance with medical ethics, and obtains a satisfactory auricular shape. The comprehensive treatment plan of surgery plus postoperative pressure can effectively prevent postoperative recurrence of ear keloid after follow-up, with satisfactory treatment results, few complications, safety, simple method and easy acceptance by patients, and can be widely used in clinical practice.