How to minimize the recurrence rate of keloids after surgery is a question that doctors need to consider and patients want to know about. There are many ways to prevent recurrence of keloid scars, but very few that can stand up to the test of clinical effectiveness. Nearly a decade of treatment experience has shown that at the therapeutic level, the following three techniques have a more definite effect on keloid recurrence prevention and can be considered key techniques for preventing keloid recurrence.
1. Tension reduction This is a recurrence prevention technique related to surgery. Although keloid excision seems to be simple, it requires a high level of surgical skills, especially the reduction suture technique, which directly determines the recurrence rate and the aesthetics of the healing incision after surgery. Under the same conditions, the better the tension-reducing suture technique, the lower the recurrence rate of the keloid, the narrower the scar after the incision is healed, and the more aesthetically pleasing the area will be. Therefore, when performing keloid surgery, the surgeon should master the correct incision reduction method and use it skillfully to lay a good surgical foundation for recurrence prevention.
2. Local radiation irradiation Local radiation irradiation is also known as radiation therapy, or radiotherapy for short. But here I do not want to use the word “radiotherapy”, because the concept of “radiotherapy” will cause ambiguity. First, “radiation therapy” can be confused with malignancy treatment. Although the equipment used for radiation therapy for keloids is the same as that used for malignant tumors, the dose and biological effects of appropriate postoperative radiation for keloids are not identical to those of radiation therapy for malignant tumors, and the serious side effects of radiation therapy for malignant tumors, such as tissue necrosis, severe hair loss, and cancer, are almost never seen. Secondly, the term “radiotherapy” may confuse people about the effects of different radiation irradiation techniques. Theoretically, all radiation techniques that produce radiation and are used to produce biological effects on the body are radiation therapy techniques. These techniques include local application of isotopes (e.g. various dressings), X-ray irradiation, electron ray irradiation, etc. However, not all radiation therapy techniques are effective in preventing postoperative recurrence of keloids, and, even for the same technique, not all application methods (e.g., application time, frequency, dose, etc.) are effective. Clinical practice proves that the correct type of radiation, the correct duration of action, and the correct dose of radiation are indispensable for the prevention of keloid recurrence in terms of local radiation exposure. Therefore, after keloid surgery, local radiation irradiation should be properly implemented as an adjunctive treatment. Effective local radiation therapy should meet the following requirements: (1) the site and depth of radiation action are precisely controlled; (2) the treatment dose and duration produce optimal biological effects; and (3) radiation damage is controlled to a minimum.
Local pressure is the third aspect of keloid recurrence prevention and rehabilitation after keloid surgery. I have elaborated on local compression in other articles, so I will only emphasize two points here.
(1) Although local compression is an effective recurrence prevention measure, this technique does not work as well as it should because of the lack of appropriate means and supplies, and the long treatment time, which can cause inconvenience to work life and poor patient acceptability.
(2) The reliance on medical treatment and medical technology and the neglect of rehabilitation and self-healing autonomy are the weaknesses of Chinese medical care. Many keloid patients have the same misconceptions. Due to this misconception, patients tend to have a mentality of giving themselves to the doctor, only attaching importance to the medical process and not to the rehabilitation process, and unsatisfactory results rarely look for reasons from the rehabilitation process and from themselves, which to a certain extent also limits the promotion of local pressure as a rehabilitation technique. Clinical case data show that patients who insist on postoperative pressure rehabilitation treatment have good recovery of the surgical site, no recurrence and better local aesthetics, while patients who do not insist on pressure rehabilitation treatment have a higher incidence of recurrence and scar enlargement. In addition, as a scar rehabilitation measure, local compression therapy has long been commonly used internationally and has even become an indispensable part of post-burn scar treatment. Of course, the implementation of this treatment technology also depends on the development and promotion of related products. Currently, domestic products such as personalized elastic compression garments can be produced, and it is believed that this technology will bring good news to keloid patients in the near future.
One year after excisional radiotherapy and compression therapy for chest keloid. The incision scar is flat and without hyperplasia.