T. Tsuge1, M. Aoki1, S. Akaishi1, T. Dohi1, H. Yamamoto1, R. Ogawa1 1Nippon Medical School,Plastic, Reconstructive And Aesthetic Surgery,Tokyo, TOKYO, Japan
Introduction: The current treatment for severe keloids is surgery followed by postoperative radiation. The possibility of recurrence after surgery is high without strict follow-up treatment. Some specific suture methods are thought to be effective for preventing recurrence. Stretching tension is an important factor associated with keloid generation and progression. We believe that suture methods that prevent tension occurring in the dermis are effective. We have attempted a fascial tensile reduction (FTR) method in severe keloid surgery over the long term. Tension after the resection of keloids is strong in the anterior chest, and we have tried the combination of deep fascia tensile reduction (DFTR) and superficial fascia tensile reduction (SFTR). We analyzed the effects of SFTR and the combination of DFTR and SFTR (DFTR+SFTR).
Methods: Geometric analysis was performed by Obtaining Anatomic Shapes in 3D using DISCUS drawing software and ADINA analytical software. All keloids were treated by surgery and postoperative radiation therapy. The data set consisted of 386 patients who were treated surgically from 2011 through 2016 in the Department of Plastic, Reconstructive and Aesthetic Surgery of Nippon Medical School in Tokyo. Among the patients, 77 with anterior chest severe keloids who underwent fascial tensile reduction and were followed for over 18 months after surgery were used as the subjects of this study. The patient characteristics, surgical outcomes, and recurrence rates at the point of 18 months after surgery were analyzed.
Results:The maximum mechanical force to the dermis was 4700 Pa when only a dermal suture was used, whereas that to the dermis was decreased to the maximum of 573 Pa with additional SFTR. DFTR+SFTR decreased the force to the superficial fascia compared with SFTR. The percentage of total keloid excision was significantly higher in the group of DFTR+SFTR (60.0%) than in the group of SFTR (34.6%). The length of hospital stay in the DFTR+SFTR group was significantly longer than in the SFTR group. At the point of 18 months after surgery, no recurrence was recognized in 44.0% and 51.9% of the patients in the DFTR+SFTR group and the SFTR group, respectively. Signs of recurrence or residual keloids were observed in 54.0% and 44.4% of the patients in the DFTR+SFTR group and the SFTR group, respectively. Only 1 case in the DFTR+SFTR group (2.0%) and 1 case in SFTR group (3.7%) were judged to be obvious recurrence. Statistical analysis detected no significant difference between the 2 groups (p=0.670).
Conclusion:DFTR + SFTR should be selected in cases of total resection with relatively large keloids. DFTR appears to facilitate SFTR, and is considered to be useful when reduction by SFTR is technically difficult. It was found that the additional DFTR did not lower the recurrence rate.