(A403) Adjuvant treatments to prevent recurrence keloid in the ear: case report

Introduction: Case report of bilateral surgical excision of keloids with intraoperative triamcinolone infiltration afterwards, the post-operative period consisted of the application of triamcinolone to the surgical wound and local radiotherapy with electron beams to prevent recurrence.

Methods: Patient underwent bilateral otoplasty to correct prominent ears, in December 2016, without intraoperative complications. However
progressively evolved with such injuries that went beyond the limits of the wound original, characterized as keloids.
Therefore, in November 2021, it was decided to undergo bilateral surgical excision of keloids with triamcinolone infiltration intraoperatively. Subsequently, the post- surgery consisted of applying triamcinolone to the surgical wound and performing local electronic therapy to prevent recurrence.
Three radiotherapy sessions with electron beams were carried out in the with a daily dose of 200 centigrays (cGy), corresponding to a total of 1,500 cGy in each ear, on non-consecutive days, the first 24 hours after the surgical procedure, the second after 6 days and the last 8 days after surgery.
The patient received topical, intralesional corticosteroid therapy intraoperatively, 30 days after the procedure and also after 90 days at a dose of 1 ml in each ear of triamcinolone (20 mg/ml).

Results: After 2 years, 2 months, and 21 days of clinical follow-up, the patient shows no signs of hypertrophic lesion or keloid.

Conclusions: Intralesional corticosteroid therapy and electron beam radiotherapy constitute good options as adjuvant treatment to prevent recurrences of
keloid. However, it is important to highlight that prevention is essential in the process of surgical wound healing. It is more efficient to employ preventive measures against keloids, since treatments still have high rates of recurrence. The use of the appropriate surgical technique, reducing manipulation and excessive trauma, as well as care for bruises and infections are measures of early intervention to avoid failures in the reparative process and provide better quality of life for the patient post-surgery.