Use of Integra and interval brachytherapy in a 2-stage auricular reconstruction after excision of a recurrent keloid.
Use of Integra and interval brachytherapy in a 2-stage auricular reconstruction after excision of a recurrent keloid.
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在切除复发性瘢痕疙瘩后进行两阶段耳廓重建中使用 Integra 和间隔近距离放射治疗。
DOI：
10.1097/scs.0b013e3182587388
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发表时间：
2012
期刊：
影响因子：
--
通讯作者：
Spector,JasonA
中科院分区：
文献类型：
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作者：
Reiffel,AlyssaJ;Sohn,AllieM;Henderson,PeterW;Fullerton,Natalia;Spector,JasonA
瘢痕疙瘩是一项艰巨的临床挑战。手术切除配合放射治疗可减少瘢痕疙瘩复发的机会。然而，在放疗的情况下，分厚皮肤移植更容易失败。在本报告中，我们报告了一位复发性耳穴瘢痕疙瘩患者，他接受了手术切除和立即应用Integra (Integra LifeSciences, Plainsboro， NJ)，随后进行了高剂量率近距离治疗和间隔裂厚皮肤移植。一位23岁的女性，既往手术切除、皮质类固醇注射和放疗后复发性耳廓瘢痕疙瘩，再次接受了瘢痕疙瘩切除术。Integra用于覆盖由此暴露的耳软骨膜。术后第1天和第2天，患者接受高剂量率近距离放疗（1500 cGy），术后第3周，患者接受分厚皮肤移植。所有干预后患者均恢复正常，无并发症。在耳廓受体或大腿供体部位间隔层厚皮肤移植27个月后没有瘢痕疙瘩形成的证据。我们报告了第一例复发性耳廓瘢痕疙瘩的两阶段重建（包括瘢痕疙瘩切除和放置Integra，结合高剂量率近距离治疗，然后是间隔裂厚皮肤移植），在长期随访中获得了可接受的美容效果，没有复发的证据。
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 (Integra LifeSciences, Plainsboro, NJ) application, followed by high–dose rate brachytherapy and interval split-thickness skin graft placement. A 23-year-old woman with a history of a recurrent auricular keloid after previous surgical excision, corticosteroid injection, and radiation underwent reexcision of her keloid. Integra was used to cover the resultant exposed auricular perichondrium. The patient then received high–dose rate brachytherapy (1500 cGy) on postoperative days 1 and 2, followed by definitive split-thickness skin graft placement 3 weeks after her initial surgery. The patient recovered from all interventions without complication. There was no evidence of keloid formation 27 months after the interval split-thickness skin graft placement at either the auricular recipient or thigh donor sites. We report the first case of a 2-stage reconstruction of a recurrent auricular keloid (composed of keloid excision and placement of Integra in conjunction with high–dose rate brachytherapy, followed by interval split-thickness skin grafting), resulting in an acceptable cosmetic result without evidence of recurrence at long-term follow-up.