Use of Integra® and Interval Brachytherapy in a Two-Staged Auricular Reconstruction Following Excision of a Recurrent Keloid

摘要

Keloids present a formidable clinical challenge. Surgical excision in conjunction with radiation therapy may decrease the chance of keloid recurrence. Split-thickness skin grafts, however, are more prone to failure in the setting of radiation. In this report, we present a patient with a recurrent auricular keloid who underwent excision and immediate Integra^® application, followed by high dose rate brachytherapy and interval split-thickness skin graft placement. A 23-year old female with a history of a recurrent auricular keloid after previous surgical excision, corticosteroid injection, and radiation, underwent re- excision of her keloid. Integra^® was used to cover the resultant exposed auricular perichondrium. The patient then received high dose rate brachytherapy (1500 cGy) on post-operative days 1 and 2, followed by definitive split-thickness skin graft placement 3 weeks following her initial surgery. The patient recovered from all interventions without complication. There was no evidence of keloid formation 27 months following interval split- thickness skin graft placement at either the auricular recipient or thigh donor sites. We report the first case of two-staged reconstruction of a recurrent auricular keloid (comprised of keloid excision and placement of Integra^® in conjunction with high dose rate brachytherapy, followed by subsequent interval split-thickness skin grafting), resulting in an acceptable cosmetic result without evidence of recurrence at long-term follow-up.