Keloids are raised scars forming after skin injury, extending beyond original wound boundaries. Unlike typical scars that flatten, keloids continue to grow, forming firm, rubbery lesions. Surgical excision is a common treatment, aiming to remove overgrown tissue. It is often combined with other therapies to reduce recurrence.
Understanding Keloids
Keloids are smooth, shiny, firm, rubbery masses, often reddish or purplish. Unlike hypertrophic scars, which stay within the original injury site and may diminish, keloids grow beyond wound edges and do not regress without treatment. Their collagen fibers are disorganized, unlike the regular pattern of hypertrophic scars.
They commonly form on earlobes, chest, shoulders, and back, but can appear anywhere. They often arise from skin injuries like cuts, burns, surgical incisions, piercings, and acne scars. Genetic predisposition is a factor, with higher likelihood in those with a family history. Certain populations, especially those with darker skin tones, also show increased susceptibility.
The Excision Procedure
Excision involves surgically removing overgrown scar tissue. Beforehand, the site is cleaned and marked. Anesthesia is administered for comfort: local for smaller keloids, or regional/general for larger or multiple lesions. The choice depends on the keloid’s size, location, and patient preference.
During the procedure, the surgeon incises around the keloid, cutting out the abnormal tissue. The goal is to remove the entire keloid while preserving healthy surrounding skin; some techniques remove a small margin for recurrence risk reduction. After removal, the wound is closed with fine sutures, minimizing tension. Surgery lasts 30 minutes to two hours, depending on keloid number and size. Most excisions are outpatient, with patients returning home the same day.
Post-Excision Care and Recurrence Prevention
After keloid excision, post-operative care is important for healing and reducing recurrence. Immediately after surgery, the wound is dressed to protect and promote healing. Patients receive instructions on keeping the surgical area clean and dry, including bandage changes and applying ointments. Mild discomfort or swelling is common, managed with over-the-counter pain relievers. Activity restrictions, like avoiding strenuous movements or heavy lifting, are often advised to prevent strain.
Due to high recurrence risk after surgical removal alone, various adjunctive therapies are often initiated immediately after excision. Corticosteroid injections, often triamcinolone, are administered directly into the wound to reduce inflammation and suppress collagen production. These injections flatten the scar and alleviate symptoms like itching or pain. Silicone sheeting or gels are another common therapy, applied daily to the treated area once healed. These products provide pressure and hydration, softening scar tissue and contributing to a flatter appearance.
Pressure therapy involves applying continuous pressure to the treated area using custom-fit garments or devices. This method is useful for keloids on earlobes and other areas where consistent pressure can be maintained. Radiation therapy, typically low-dose, may be used post-surgery to inhibit fibroblast activity and prevent keloid regrowth, often over several sessions. Cryotherapy, freezing tissue with liquid nitrogen, can reduce keloid size by damaging scar-producing cells.
Laser therapy (e.g., pulsed dye laser) can reduce redness and improve scar texture. While sometimes used alone for smaller keloids, it is also combined with other treatments. A multi-modal approach, combining surgical excision with one or more adjunctive therapies, is most effective for successful long-term outcomes and reducing keloid recurrence.