방사선의학 웹진

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Abstract
Background: Achieving esthetically pleasing results for helical keloids can be challenging. This study aims to share the results of a treatment approach for helical keloids, which involves complete excision and reconstruction using an omega variant keystone flap, followed by a single fractional radiotherapy.

Methods: The current study is a retrospective review of 25 helical keloids in 21 patients from May 2021 to March 2023. All keloid cases were excised entirely. We covered the defect with an omega variant keystone flap followed by a single fraction of 9.5 or 10 Gy radiotherapy within 24 h after surgery. The mean follow-up period was 12 months. The primary outcome was recorded as recurrence versus non-recurrence. The secondary outcome was scores assessed by the Patient and Observer Scar Assessment Scale.

Results: All 25 keloids in 21 patients completed the treatment protocol, with a follow-up interval of 12 months. Of these patients, 100% had successful treatment of their keloids without any keloid recurrence. The postoperative course was uneventful except for one case of early postoperative flap congestion, which was spontaneously healed without any interventions. Scores obtained from the Patient and Observer Scar Assessment Scale showed that pain, itchiness, color, stiffness, thickness, irregularity, vascularity, pigmentation, thickness, relief, and pliability significantly improved. (p < 0.001).

Conclusions: We successfully reconstructed helical keloids using an omega variant keystone flap after keloid removal followed by 9.5 or 10 Gy single fractional radiotherapy without any keloid recurrence in one-year follow-ups.

1990년, 미국 메사츄세츠주 Dr. Theodore 등은 10Gy single fraction 방사선 치료를 수술 직후 24시간 내에 하면 효과가 있을 수 있다는 것을 Radiotherapy and oncology에 발표한 바 있습니다. (그림1)

최근 2022년 고려대학교 안암병원의 성형외과 및 방사선종양학과에서 같은 그린 저널에 발표한 메타분석의 Table 2에 의하면 single fraction으로 치료한 귀켈로이드 연구가 부재한 것으로 알려져 있습니다. (그림2)

Affiliation

Tae Hwan Park 1
1Department of Plastic and Reconstructive Surgery, Dongtan Sacred Heart Hospital, Hallym University College of Medicine, Hwaseong, Republic of Korea. Electronic address: plasticpth@gmail.com.