Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2015 Aug 10;3(7):e440.
doi: 10.1097/GOX.0000000000000357. eCollection 2015 Jul.

Surgical Excision with Adjuvant Irradiation for Treatment of Keloid Scars: A Systematic Review

Michiel C E van Leeuwen  1 , Suzanne C Stokmans  1 , Anne Eva J Bulstra  1 , Otto W M Meijer  1 , Martijn W Heymans  1 , Johannes C F Ket  1 , Marco J P F Ritt  1 , Paul A M van Leeuwen  1 , Frank B Niessen  1
Affiliations
Review

Surgical Excision with Adjuvant Irradiation for Treatment of Keloid Scars: A Systematic Review

Michiel C E van Leeuwen et al. Plast Reconstr Surg Glob Open. .

Abstract

Background: Excision followed by adjuvant irradiation is considered safe and most efficacious for treatment of keloid scars. Recently, different authors published successful treatment protocols and recommended the following: (1) the use of high-dose-rate brachytherapy instead of low-dose-rate brachytherapy or external radiation; (2) a short-time interval between operation and irradiation; (3) single fraction instead of multifraction irradiation; and (4) a minimum of 12- to 24-month follow-up post treatment.

Methods: This study evaluates the above recommendations with a systematic review of the English-language literature, based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis statement. Both PubMed and EMBASE were searched. Studies were graded according to the American Society of Plastic Surgeons Rating Levels of Evidence.

Results: Thirty-three studies were selected. Six studies were graded as level of evidence type II studies and 27 as type III. High-dose-rate brachytherapy showed lower recurrence rates compared with low-dose-rate brachytherapy and external radiation. A short-time (<7 hours) interval between scar excision and irradiation results in a lower recurrence rate compared with long-time intervals (>24 hours). Single-fraction irradiation showed promising results in terms of recurrence rate and patient convenience. Finally, scar recurrences were seen between 2 and 36 months, with a mean of 15 months.

Conclusions: Based on this systematic review of the literature, the evidence confirms the recommendations stated by authors in the recent years. However, due to the lack of high-quality randomized studies, the quality of this evidence is limited. More randomized studies will generate stronger recommendations.

PubMed Disclaimer

Conflict of interest statement

Disclosure: The authors have no financial interest to declare in relation to the content of this article. A portion of the Article Processing Charge was paid for by PRS Global Open at the discretion of the Editor-in-Chief. The remainder of the Article Processing Charge was paid for by the authors.

Figures

Figure 1.
Figure 1.
Surgical excision with adjuvant brachytherapy. Example of an auricular keloid scar (A) with surgical excision (B). C, A catheter is positioned between the dermal edges of the wound, below the surface of the skin and extending out of the skin beyond the wound. Postoperatively, the patient will be transferred to the radiation department for the adjuvant high-dose-rate brachytherapy (Source: van Leeuwen MC, Stokmans SC, Bulstra AE, et al. High-dose-rate brachytherapy for the treatment of recalcitrant keloids: a unique, effective treatment protocol. Plast Reconstr Surg. 2014;134:527–534).
Figure 2.
Figure 2.
Flow diagram of the search and selection process according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis.
See this image and copyright information in PMC

References

    1. Niessen FB, Spauwen PH, Schalkwijk J, et al. On the nature of hypertrophic scars and keloids: a review. Plast Reconstr Surg. 1999;104:1435–1458. - PubMed
    1. Bock O, Schmid-Ott G, Malewski P, et al. Quality of life of patients with keloid and hypertrophic scarring. Arch Dermatol Res. 2006;297:433–438. - PubMed
    1. Mustoe TA, Cooter RD, Gold MH, et al. International Advisory Panel on Scar Management. International clinical recommendations on scar management. Plast Reconstr Surg. 2002;110:560–571. - PubMed
    1. Sequeira JH. Case illustrating the effects of x-rays on scar-keloid. Proc R Soc Med. 1909;2:96–98. - PMC - PubMed
    1. Kreulen M, Van De Kar A. Long-term follow-up in the treatment of keloids by combined surgical excision and immediate postoperative adjuvant irradiation: reply. Plast Reconstr Surg. 2008;121:700–701. - PubMed