Surgery plus radiotherapy keeps the helical keloid scar away
Reviewed by Shivanchan Rajmohan

Keloid scars lead to significant psychological and cosmetic morbidity. As the pinna is a key component of facial cosmesis, pinna keloid scar formation can be aesthetically displeasing. Their stubbornness and high recurrence rate can be challenging to treat. This department, based in Korea, retrospectively examined outcomes one year after utilising the Omega Variant Keystone Flap (OVKF) alongside adjuvant single fraction 9.5-10Gy radiotherapy within 24 hours of complete excision of helical keloid scars in 21 female patients. Eighty-eight percent keloid formation was secondary to piercings, with 12% following previous auricular surgery. The primary outcome was binary inspecting keloid recurrence after 12 months, with authors assessing scar quality using the ‘Patient and Observer Scar Assessment Scale (POSAS). A hundred percent exhibited no recurrence at 12 months in addition to statistically significant improvement in POSAS scores including pain and pruritus. Notably, 68% cases previously had failed keloidectomies and 84% previously had intralesional steroid injections. Local OVKFs aims to retain optimal blood supply through less wound tension and, when compared to grafts, generally offer superior survival rates, provided good surgical technique is demonstrated. The potential adverse impact of radiotherapy on graft survival makes local flaps more appealing. Minimal interruption to perforator vessels is imperative to flap survival, thus less surgical manipulation is recommended. Randomised controlled trials inspecting recurrence following single versus double versus triple modality treatment for auricular keloid scars are warranted; there is contention with respect to administration order of postoperative adjunctive therapies for keloid scars. OVKFs absolute reduction in keloid recurrence compared to traditional keystone flap for helical keloids needs further research. One may argue the additional perpendicular scar to the long axis left after OVKF is insignificant if it produces lower keloid recurrence compared to the traditional design. Issuing radiotherapy whilst associated with low secondary malignancy risk should grant patients long-term follow up.

Outcomes of omega variant keystone flap in conjunction with single fraction radiotherapy for helical keloids: A comprehensive one-year follow-up study.
Park TH.
J PLAST RECONSTR AESTHET SURG
2023:S1748–6815(23)00502–8.