Author(s)
Amelia K. Ramsey BS
Kevin A. Moore MD
Kaveh K. Karimenjad MD
Paul M. Weinberger MD
Paige E. Bundrick MD
Affiliation(s)
Louisiana State University Health Sciences Center School of Medicine
Abstract:
Educational Objective: At the conclusion of this presentation, the participants should be able to discuss how perioperative factors can play a role in the recurrence of keloids. Objectives: To assess the effect of various perioperative factors on ear keloid recurrence and time to recurrence. Study Design: IRB approved retrospective chart review. Methods: We examined suture type (nonabsorbable vs. absorbable), method of excision (scalpel vs. CO2 laser), and postoperative steroid use for patients surgically treated for ear keloids. In order to determine a correlation between primary variables and the time to keloid recurrence, we used Kaplan-Meier survival curves with log rank statistic for determining significance. In addition, a contingency table analysis with Fisher's exact was used to examine the correlation between the type of suture, method of excision, and steroid use. Results: No statistically significant correlation between our examined factors (nonabsorbable vs. absorbable suture, scalpel vs CO2 laser, or postoperative steroid use) and outcomes of keloid recurrence or time to keloid recurrence was found. There was a possible trend for earlier recurrence of ear keloids with the CO2 laser with a median recurrence of 38 +/- 246 days compared to the scalpel excision with a median recurrence of 272 +/- 228 days, however, these results were not statistically significant. Conclusions: Based on our results, we cannot reject our null hypothesis as there was no statistically significant correlation between our examined factors (nonabsorbable vs. absorbable sutures, scalpel vs. CO2 laser, or postoperative steroid use) and outcomes of keloid recurrence or time to keloid recurrence, though we did see a possible trend for earlier recurrence when the CO2 laser was used. Various therapies developed over the years to impede keloid formation have not shown standardized clinical improvements, necessitating a better understanding of physiologic mechanisms of wound healing and how surgical techniques and postoperative therapy contribute to recurrence of keloids. A larger, prospective study with standardized initiation of postoperative steroids and standardized followup visits could show a correlation between perioperative factors and ear keloid recurrence. To our knowledge this is the only study directly comparing nonabsorbable vs. absorbable sutures as well as scalpel and CO2 laser use.