Prevention
Prevention is undoubtedly vital for keloid scars because of the difficulty with treating established lesions.
Basic surgical precepts include:
- avoiding all but essential surgery in individuals with a strong personal or family history of keloid scarring
- incise along relaxed skin tension lines and close wounds under no tension
- reduce the risk of infection with thorough debridement and elimination of 'dead space'
- perfect apposition of skin edges with gentle eversion
- avoidance of placing scars in areas of the body that are more prone to keloid scarring including the pre-sternal area, deltoid area of the shoulder and on the earlobes
When a keloid is established, a number of techniques have been used to prevent recurrence after further surgery is undertaken on the site. These include:
- steroid injection into the surrounding skin at the time of keloid excision
- compression to the site of excision eg the ear lobule with dedicated compression earrings
- radiotherapy to the site
None of these techniques are completely effective. They are considered in the section on 'treatment'.
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