Introduction: Crossing centuries, great inquiries are still portrayed in medicine. Abnormal healing becomes one of these mysteries not completely unraveled. Keloid and hypertrophic scars are characterized by abnormal responses to the healing process. They present intense production and deposition of collagen and glycoproteins in the dermis, with consequent development of a pathological scar. Keloid and hypertrophic scars arouse an important aesthetic and psychological appeal, especially when present in regions such as the face, causing embarrassment and changes in social relationships. Due to this, when carrying out a review of the literature, there are many papers talking about the subject keloid, being at experimental or clinical level, however there is no consensus on which method is best done in its handling and treatment.
Objective: Describe a new approach to keloid resection preserving its epithelium and dermis as cover in cases where transplantation would be necessary.
Method: Report three cases of keloid in ear in young patients, one in the lobe and two in the ear helix, all with low or absent clinical activity (hyperemia, pain and/or pruritus and absence of growth).
In the first case, the patient was previously treated with intralesional corticoid injections, surgical resection and radiotherapy, but recurred with keloid formation predominantly in the ear lobe. On this time, it was treated with the technique described by Kim DY et al. as keloid fillet flap added to adjuvant beta-therapy, with no signs of recurrence until the present moment of follow-up and with a tension-free primary closure.
In the second case, the patient presented keloid formation in the upper extremities of ears after performing otoplasty. Such patient was treated with intralesional injections of corticoid (triamcinolone acetonide) followed by surgical procedure, also with cited technique, and adjuvant beta-therapy, providing a primary closure of the lesion without tension.
The third case, reports about a keloid recurrence in upper auricular helix after two procedures of excision and local skin grafting. In this case it was also made intralesional injections of triamcinolone acetonide, followed by a surgical approach with the keloid fillet flap technique and beta-therapy adjuvant also carried out tension-free primary closure.
Results: In the short follow-up period, no recurrences, suture dehiscence, hematomas / seromas, or areas of tissue necrosis were observed. Patients remain without clinical signs of keloid activity.
Conclusion: Cases where clinical signs of keloid activity, hyperemia, pruritus, local pain and growth are not observed, as well as areas where there is no possibility of primary closure after complete resection, including large masses, conservative surgical approach provides a very pertinent alternative.
Techniques that cause minor morbidities to the patients and preserve the local anatomy after resection of the lesions and that do not increase the rates of recurrence and/or complications, are portrayed as ideal. Thus, these reports corroborate a new approach to some forms of keloid lesions with the objective of better patient outcomes and without the need for skin grafts or distant flaps.
Daniel Sundfeld Spiga Real, Maynara Zoppei dos Santos, Bernardo Sérgio Hochman and Lydia Masako Ferreira
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