Earlobe
keloid can form after cosmetic
ear piercing,
trauma, or
burns, and it poses several difficulties in treatment and distinctive cosmetic implications. Treatment methods for earlobe
keloids include both surgical and nonsurgical methods. After excision of the earlobe
keloid, healing by secondary intention, primary
suture, skin graft, or local flap has revealed some disadvantages. The authors approached this problem with a new excision and covering method. The surgery was performed under
local anesthesia. Skin over the
keloid was dissected from the
keloid mass as a flap, which they termed a "
keloid fillet flap," and the
keloid mass was completely removed. Subcutaneous
sutures were not used, and the
keloid fillet flaps were closed with 6-0
nylon sutures after trimming. Other intraoperative or postoperative preventive procedures, such as
steroid injection, pressure device, or irradiation, were not applied primarily. In the period from May of 1999 to October of 2000, nine earlobe
keloids in eight patients were treated with this protocol. One patient had bilateral
keloids. Of the eight patients, there were six women and two men, ranging in age from 21 to 61 years (mean age, 28.5 years). The causes of
keloids were
ear piercing in six cases and
trauma in three cases. The largest lesion was 3 cm in its greatest dimension, and the smallest was 1.5 cm (mean, 2.3 cm). All flaps survived completely. There were four cases of recurrence. Seven cases, including two recurrences, showed good results. The authors believe the recurrence of earlobe
keloid was closely related to the method for coverage of the defect after its surgical excision, and the "5 As and one B" (Asepsis, Atraumatic technique, Absence of raw surface, Avoidance of tension, Accurate approximation of
wound margin, and complete
Bleeding control) are important factors in reducing the recurrence rate of earlobe
keloids in surgical excision. The authors' protocol is very effective in closing the defect after surgical excision of earlobe
keloids and offers many advantages over other surgical approaches. The recurrence rate of earlobe
keloid may be lower than in their results if other intraoperative and postoperative treatment procedures are combined with their protocol.