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. 2018;19(11):853-862.
doi: 10.1631/jzus.B1800132.

Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate

Ke-Xin Song  1 , Shu Liu  2 , Ming-Zi Zhang  1 , Wei-Zhong Liang  3 , Hao Liu  1 , Xin-Hang Dong  1 , You-Bin Wang  1 , Xiao-Jun Wang  1
Affiliations

Hyperbaric oxygen therapy improves the effect of keloid surgery and radiotherapy by reducing the recurrence rate

Ke-Xin Song et al. J Zhejiang Univ Sci B. 2018.

Abstract

Objective: Keloids are exuberant cutaneous scars that form due to abnormal growth of fibrous tissue following an injury. The primary aim of this study was to assess the efficacy and mechanism of hyperbaric oxygen therapy (HBOT) to reduce the keloid recurrence rate after surgical excision and radiotherapy.

Methods: (1) A total of 240 patients were randomly divided into two groups. Patients in the HBOT group (O group) received HBOT after surgical excision and radiotherapy. Patients in the other group were treated with only surgical excision and radiotherapy (K group). (2) Scar tissue from recurrent patients was collected after a second operation. Hematoxylin and eosin (H&E) staining was used to observe keloid morphology. Certain inflammatory factors (interleukin-6 (IL-6), hypoxia-inducible factor-1α (HIF-1α), tumor necrosis factor-α (TNF-α), nuclear factor κB (NF-κB), and vascular endothelial growth factor (VEGF)) were measured using immunohistochemical staining.

Results: (1) The recurrence rate of the O group (5.97%) was significantly lower than that of the K group (14.15%), P<0.05. Moreover, patients in the O group reported greater satisfaction than those in the K group (P<0.05). (2) Compared with the recurrent scar tissue of the K group, the expression levels of the inflammatory factors were lower in the recurrent scar tissue of the O group.

Conclusions: Adjunctive HBOT effectively reduces the keloid recurrence rate after surgical excision and radiotherapy by improving the oxygen level of the tissue and alleviating the inflammatory process.

Keywords: Keloid; Hyperbaric oxygen therapy; Surgical excision; Radiotherapy; Recurrence rate.

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Conflict of interest statement

Compliance with ethics guidelines: Ke-xin SONG, Shu LIU, Ming-zi ZHANG, Wei-zhong LIANG, Hao LIU, Xin-hang DONG, You-bin WANG, and Xiao-jun WANG declare that they have no conflict of interest.

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2008 (5). Informed consent was obtained from all patients for being included in the study. Additional informed consent was obtained from all patients for whom identifying information is included in this article.

Figures

Fig. 1
Fig. 1
Vancouver scar scale score of partially cured plus recurrent keloids in the O and K groups Higher scores denote keloids that are more serious. Data are expressed as mean±standard deviation (SD; O group, n=15; K group, n=26). ** P<0.01, vs. the O group
Fig. 2
Fig. 2
Keloid recurrence in the O group Small partial recurrences were observed (black arrowheads). (a) Surgical excision with primary closure was performed on a 27-year-old female with keloids caused by breast acne; (b) Surgical excision with internal thoracic perforator vessel skin flap was performed on a 35-year-old male with keloids caused by mass acne; (c) Surgical excision with primary closure was performed on a 42-year-old male with keloids caused by trauma
Fig. 3
Fig. 3
Keloid recurrence in the K group A more serious keloid recurrence was observed in the K group than in the O group. Keloid recurrence was noted over almost all of the incision sites in many of the patients (black arrowheads). The recurrence time was shorter than that in the O group. (a) A 65-year-old female underwent keloid removal and skin graft for keloids caused by acne; (b) Surgical excision with primary closure was performed on a 52-year-old male with keloids caused by acne; (c) Surgical excision with superficial circumflex iliac artery perforator skin flap transplantation was performed on a 31-year-old male with keloids caused by acne
Fig. 4
Fig. 4
Average blood perfusion of the keloid tissue in recurrent patients (a) The blood perfusion detecting image; (b) Average blood perfusion of the R-O and R-K groups (R-O: recurrent patients from the O group; R-K: recurrent patients from the K group). The white arrows indicate keloid blood perfusion. Red represents high blood perfusion. Data are expressed as mean±SD (R-O group, n=8; R-K group, n=15). ** P<0.01, vs. the R-O group (Note: for interpretation of the references to color in this figure legend, the reader is referred to the web version of this article)
Fig. 5
Fig. 5
Results of H&E staining of epidermis and dermis in the R-O and R-K groups Numerous fibroblasts and a large amount of inflammatory infiltration can be observed. Thick and extremely compact collagen fibrils appear disordered. Arrows represent inflammatory cells
Fig. 6
Fig. 6
Immunohistochemical studies of all factors (a) Immunohistochemical studies of IL-6, HIF-1α, TNF-α, NF-κB, and VEGF in the R-K and R-O groups. In the R-K group, the expression of all these inflammatory factors was higher than that in the R-O group. (b) Percentage of positively stained cells. Data are expressed as mean±SD (R-O group, n=8; R-K group, n=15). *** P<0.001, vs. the R-K group
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