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Keloid Management

It is well known that the risk of keloid rebound following scar revision is
very high. The patient not only has to endure the physical problems of painful and
sensitive scars, but also the significant psychological impact, especially if the
scar is located in a prominent area such as the ears. Treatment of ear keloids is
notoriously difficult and usually involves the use of a Zimmer splint, or clip on
earrings. This method is problematic and is only of limited use, if the keloid is
located on the ear lobe. With a fashion trend for both males and females having
piercings to the upper aspect of the ear, resulting keloids would be impossible to
treat using the above method. The problem of location also presents itself with
the development of keloid scarring to the post auricular area following pinnaplasty.
A child who has undergone pinnaplasty to change their cosmetic appearance, only to
suffer large scar formations resistant to available treatments, can experience
severe psychological impact.

 

Treatment

The use of pressure to treat keloid scarring is far from new and custom made
splints have been in use for some time. These are usually opaque, of oyster type
design, with nuts and bolts used to secure the splint in place.
One of the main problems with these splints, is that when the patient presents
with a keloid scar, it is already well established and, as a consequence, unlikely
to respond to the limited available treatments.

 

Keloid Splint.

 

After treatment.

 

Surgical scar revision of keloids is commonplace, but the risk of rebound can
be in excess of 80%. We have studied this problem for some time and have come
to the obvious conclusion that no one treatment method, or approach, works. We
have, over the past few years, developed a treatment protocol that has proved
successful. This follows a time line approach.

 

  1. Good patient selection as compliance with the protocol is key.
  2. The use of intralesional steroid injections in an attempted to reduce scar activity.
  3. Planned surgical debulking of the keloid.
  4. Follow up 7 – 10 days following surgery to allow swelling to reduce.
  5. At this time an extremely accurate impression is taken of the ear/ears.
  6. Fabrication of a custom made splint using quality materials and new design.
  7. Patient is fitted with splint 5 days later.
  8. Patient also begins use of silicone gel or sheeting as directed.
  9. Patient is reviewed after 7 days to monitor for pressure issues and compliance.
  10. Patient continues to be monitored and treatment adjusted as required
  11. Splint may need to be worn for up to 1 year.

After step three, Artizan will take over the treatment process. The patient
only needs to see the consultant again if there is a need for intralesional
steroids to be used. The consultant will be sent reports and photographs to keep
them updated.

The use of this protocol will not offer a 100% success. However, we feel that,
if each step is followed, the risk of scar rebound is drastically reduced. The
use of our unique custom made splint is very well tolerated by the patient.
We have overcome the problem of tissue necrosis that other splint designs suffer
from by the use of a clear acrylic. As stated above, the use of splintage in
the treatment of keloids is far from new. However, existing designs are poor
and the use of Zimmer Splint is stone age! Most patients present with an active
keloid and it is therefore very unlikely that splintage will be of any use.
Planning is the key. The patient undergoing scar revision.

Helix splint - Closeup

The close-up image to the left shows the precision fit which can be achieved using our technique and materials.

As the image shows, the split fits closely to all of the undercuts and details of the ear.

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