DOI: 10.1097/SAP.0b013e3180a032f3

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PMID: 17721234

Issn Print: 0148-7043

Publication Date: 2007/09/01


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Intraoperative Repiercing for Earlobe Keloid

Rei Ogawa; Hiko Hyakusoku; Satoshi Akaishi; Shunich Nomoto; Shimpei Ono

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In our facility, earlobe keloids have been treated with multimodal therapy, including steroid injection/ointment/tape, simple excision, postoperative radiation, and taping fixation.1 Although repiercing should usually be avoided to prevent recurrence after the surgical removal of a keloid, we attempted repiercing in response to the strong desire of many patients with extirpated keloids for this type of cosmetic intervention. Thus, we will discuss the repiercing of earlobes after surgery and the total management of patients in this report.
From January 2003 to December 2005, 58 earlobe keloids in 41 patients were treated with simple excision and postoperative radiation (4-MeV electron beam; 10 Gy/2 fractions/2 days) in our facility. As 7 out of 41 patients expressed a strong preference for repiercing, we tried intraoperative repiercing for these patients.
During the operation, the keloid was extirpated, together with a minimal margin of normal skin. The excision was made from the anterior to the posterior earlobe, and the keloid was hollowed out. In some cases, a wedge incision was made on the earlobe, and the shape was trimmed. After hemostasis and suture with 6-0 nylon, the outer tube of an elaster needle was inserted into the wound. Then, the thread was put through the tube and tied. Five Gy of electron-beam irradiation was delivered on the day after the operation and continued for a total of 2 days. At 7 days after the operation, sutures were removed, but the tube was kept in place for 3 weeks. Then, the tube was removed and repiercing was attempted.
We suggested that they should put off piercing and do taping fixation during sleep. Moreover, to avoid friction, we advised that patients should not sleep with the affected side of their head face down on the pillow. After 18 months' follow-up, there was no recurrence in 7 patients with repierced ears (Fig. 1). The total recurrence rate of operated earlobes was 3.5% (2 of 58 earlobes). The 2 patients with recurrence were immediately treated with steroid injections, which improved the prognosis.
Previous articles have clearly shown that there are no objections about the effectiveness of keloid excision and postoperative radiation.1–3 An important concern about using radiation therapy to treat keloids is the risk of inducing malignant tumors. Of course, it is important to continue to investigate the potential association between radiation and malignancy, especially in young patients who must be monitored over long time periods. Besides surgery and postoperative radiation, the most important thing is patient self-management. Taping fixation and certain pressure devices are useful in preventing earlobe keloid.4,5
In our hospital, we make efforts to accommodate the esthetical and spiritual aspirations of our patients. Thus, we not only implement effective measures to prevent recurrence but also engage in earlobe repiercing on the patient's request. During the operation, an elaster tube for the intravenous drip is available in the operating room at all times, which makes repiercing very convenient. Eighteen months' follow-up may be considered to be quite short, but our trial with no recurrences after 18 months shows that the treatment has considerable potential. We propose that repiercing is possible if the patient is good at self-management.
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