Principle and clinical application of keloid core excision technique_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

RAN Xiaoye , LIU Yuanbo , ZHU Shan , LI Shanshan , CHEN Zixiang , HAN Tinglu , JIN Shengyang , ZHOU Mengqi ,  ZANG Mengqing

Scar & Wound Treatment Center, Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, 100144, P. R. China;

Corresponding author：

ZANG Mengqing, Email: zangmengqing@sina.com

Keywords：

Keloid; core excision; keloidal flap

DOI：

10.7507/1002-1892.202308033

Video：

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Objective To review the research progress of the principle and clinical application of keloid core excision technique. Methods The literature on keloid core excision technique at home and abroad in recent years was extensively reviewed, and the principle, development history, indications, advantages and disadvantages of this technique were summarized, and the existing controversies were analyzed. Results Keloid core excision is a technique to remove the inner fibrous core from the keloid and cover the defect with the keloidal flap. It reduces the wound tension, yields good aesthetic results in the treatment of ear keloids, and reduces the recurrence rate of keloids combining with adjuvant therapies. Conclusion The keloid core excision technique has specific advantages, yet its overall efficacy remains controversial. Further studies are imperative to explore the mechanisms regarding keloid recurrence and the vascular supply principles of the keloidal flap. It is also necessary to define appropriate surgical indications and safety protocols of this technique.

Citation： RAN Xiaoye, LIU Yuanbo, ZHU Shan, LI Shanshan, CHEN Zixiang, HAN Tinglu, JIN Shengyang, ZHOU Mengqi, ZANG Mengqing. Principle and clinical application of keloid core excision technique. Chinese Journal of Reparative and Reconstructive Surgery, 2023, 37(12): 1569-1577. doi: 10.7507/1002-1892.202308033 Copy

1.	Walliczek U, Engel S, Weiss C, et al. Clinical outcome and quality of life after a multimodal therapy approach to ear keloids. JAMA Facial Plast Surg, 2015, 17(5): 333-339.
2.	臧梦青. 增生性瘢痕和瘢痕疙瘩的诊治现状. 中华医学杂志, 2023, 103(7): 469-472.
3.	Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: Pathophysiology, classification, and treatment. Dermatol Surg, 2017, 43 Suppl 1: S3-S18.
4.	Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: A 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg, 2022, 149(1): 79e-94e.
5.	Ogawa R, Akaishi S, Dohi T, et al. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method. Plast Reconstr Surg, 2015, 135(3): 868-875.
6.	李长青, 孙晋中. 核心摘除术加局部注射曲安奈德治疗瘢痕疙瘩36例. 中华烧伤杂志, 2008, 24(6): 465-466.
7.	钱维, 周牮, 范巨峰, 等. 扇形瘢痕组织瓣修复耳廓瘢痕疙瘩去核后创面. 中华整形外科杂志, 2016, 32(4): 268-271.
8.	Luo S, Benathan M, Raffoul W, et al. Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions. Plast Reconstr Surg, 2001, 107(1): 87-96.
9.	Supp DM, Hahn JM, Glaser K, et al. Deep and superficial keloid fibroblasts contribute differentially to tissue phenotype in a novel in vivo model of keloid scar. Plast Reconstr Surg, 2012, 129(6): 1259-1271.
10.	Chong Y, Park TH, Seo Sw, et al. Histomorphometric analysis of collagen architecture of auricular keloids in an Asian population. Dermatol Surg, 2015, 41(3): 415-422.
11.	Barnes LA, Marshall CD, Leavitt T, et al. Mechanical forces in cutaneous wound healing: Emerging therapies to minimize scar formation. Adv Wound Care (New Rochelle), 2018, 7(2): 47-56.
12.	Harn HI, Ogawa R, Hsu CK, et al. The tension biology of wound healing. Exp Dermatol, 2019, 28(4): 464-471.
13.	Huang C, Murphy GF, Akaishi S, et al. Keloids and hypertrophic scars: update and future directions. Plast Reconstr Surg Glob Open, 2013, 1(4): e25.
14.	Ogawa R, Okai K, Tokumura F, et al. The relationship between skin stretching/contraction and pathologic scarring: the important role of mechanical forces in keloid generation. Wound Repair Regen, 2012, 20(2): 149-157.
15.	De Sousa RF, Chakravarty B, Sharma A, et al. Efficacy of triple therapy in auricular keloids. J Cutan Aesthet Surg, 2014, 7(2): 98-102.
16.	Conway H, Gillette R, Smith JW, et al. Differential diagnosis of keloids and hypertrophic scars by tissue culture technique with notes on therapy of keloids by surgical excision and decadron. Plast Reconstr Surg Transplant Bull, 1960, 25: 117-132.
17.	Donkor P. Head and neck keloid: treatment by core excision and delayed intralesional injection of steroid. J Oral Maxillofac Surg, 2007, 65(7): 1292-1296.
18.	Dong X, Mao S, Wen H. Upregulation of proinflammatory genes in skin lesions may be the cause of keloid formation (Review). Biomed Rep, 2013, 1(6): 833-836.
19.	Lemperle G, Schierle J, Kitoga KE, et al. Keloids: Which types can be excised without risk of recurrence? A new clinical classification. Plast Reconstr Surg Glob Open, 2020, 8(3): e2582.
20.	Apfelberg DB, Maser MR, Lash H. The use of epidermis over a keloid as an autograft after resection of the keloid. J Dermatol Surg, 1976, 2(5): 409-411.
21.	Weimar VM, Ceilley RI. Treatment of keloids on earlobes. J Dermatol Surg Oncol, 1979, 5(7): 522-523.
22.	Salasche SJ, Grabski WJ. Keloids of the earlobes: a surgical technique. J Dermatol Surg Oncol, 1983, 9(7): 552-556.
23.	Lee Y, Minn KW, Baek RM, et al. A new surgical treatment of keloid: keloid core excision. Ann Plast Surg, 2001, 46(2): 135-140.
24.	Kim DY, Kim ES, Eo SR, et al. A surgical approach for earlobe keloid: keloid fillet flap. Plast Reconstr Surg, 2004, 113(6): 1668-1674.
25.	Suliman MT. The keloid fillet flap. Plast Reconstr Surg, 2005, 116(1): 337-338.
26.	Liu S, Liang W, Song K, et al. Keloid skin flap retention and resurfacing in facial keloid treatment. Aesthetic Plast Surg, 2018, 42(1): 304-309.
27.	Hao Y, Shan M, Liu H, et al. Clinical observation of subepidermal vascular network flaps in keloid patients. Aesthetic Plast Surg, 2022, 46(4): 2015-2022.
28.	Ahmednaji NM, Wu XY, Wang YX, et al. Surgical core excision with tongue flap closure in combination with electron beam radiotherapy in the treatment of ear keloids. Dermatol Surg, 2023, 49(5S): S58-S63.
29.	李鹏程, 贾赤宇, 李月敏, 等. 手术联合术后即时放射治疗瘢痕疙瘩. 中华医学杂志, 2011, 91(45): 3223-3224.
30.	Adams BB, Gloster HM. Surgical pearl: excision with suprakeloidal flap and radiation therapy for keloids. J Am Acad Dermatol, 2002, 47(2): 307-309.
31.	Sun Q, Yu ET, Zhou Y, et al. Individualized surgery combined with radiotherapy and triamcinolone acetonide injection for the treatment of auricular keloids. BMC Surg, 2021, 21(1): 256.
32.	Qi Z, Liang W, Wang Y, et al. “X”-shaped incision and keloid skin-flap resurfacing: a new surgical method for auricle keloid excision and reconstruction. Dermatol Surg, 2012, 38(8): 1378-1382.
33.	Chen B, Wang X, Qi Z. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: Effectiveness of the core excision method. Plast Reconstr Surg, 2015, 136(4): 568e-569e.
34.	Napoleone C, Giovannelli R, Capoccetti E, et al. Use of keloid cutis as reconstructive flap of the auricle after keloid excision. Plast Reconstr Surg, 2003, 111(1): 518-519.
35.	Bednarek RS, Sequeira Campos M, Hohman MH, et al. Transposition Flaps. Treasure Island (FL): StatPearls Publishing, 2023..Bednarek RS, Sequeira Campos M, Hohman MH, et al. Transposition Flaps. Treasure Island (FL): StatPearls Publishing, 2023.
36.	Memarzadeh K, Sheikh R, Blohmé J, et al. Perfusion and oxygenation of random advancement skin flaps depend more on the length and thickness of the flap than on the width to length ratio. Eplasty 2016, 16: e12. PMID: 26958105.
37.	武晓莉, 班耀林, 陈立彬, 等. “核心剥离式”瘢痕疙瘩修薄术联合放疗的疗效分析. 组织工程与重建外科, 2023, 19(1): 22-27.
38.	蔡震, 潘博, 游晓波. Fillet瓣联合术后磁铁片加压和曲安奈德注射治疗耳廓瘢痕疙瘩. 中华医学美学美容杂志, 2014, 20(2): 103-105.
39.	Choi YJ, Lee YH, Lee HJ, et al. Auricular keloid management in Asian skin: Clinical outcome of intralesional excision and postoperative triamcinolone acetonide intralesional injection. J Cosmet Dermatol, 2020, 19(11): 3041-3047.
40.	Imanishi N, Nakajima H, Minabe T, et al. Angiographic study of the subdermal plexus: a preliminary report. Scand J Plast Reconstr Surg Hand Surg, 2000, 34(2): 113-116.
41.	Teng Y, Hao Y, Liu H, et al. Histology and vascular architecture study of keloid tissue to outline the possible terminology of keloid skin flaps. Aesthetic Plast Surg, 2022, 46(2): 985-994.
42.	Liu Q, Wang X, Jia Y, et al. Increased blood flow in keloids and adjacent skin revealed by laser speckle contrast imaging. Lasers Surg Med, 2016, 48(4): 360-364.
43.	Liang ZY, Wang YW, Hao Y, et al. Histopathologic study of keloid vascular structures shows the vascular origin pattern of keloid subepidermal vascular network flaps. Am J Transl Res 2023, 15(3): 1889-1896.
44.	El-Kamel MF, Selim MK, Alghobary MF. Keloidectomy with core fillet flap and intralesional verapamil injection for recurrent earlobe keloids. Indian J Dermatol Venereol Leprol, 2016, 82(6): 659-665.
45.	Sunohara M, Ozawa T, Harada T, et al. A technique for auricular keloid core excision using a skin biopsy punch. Aesthetic Plast Surg, 2012, 36(3): 628-630.
46.	Cerejeira D, Bonito F, António AM, et al. A 7-year experience with keloid fillet flap and adjuvant intralesional corticosteroids. J Cutan Aesthet Surg, 2021, 14(2): 172-176.
47.	Berman B, Bieley HC. Adjunct therapies to surgical management of keloids. Dermatol Surg, 1996, 22(2): 126-130.
48.	Fang F, Zhao L, Wu XF, et al. Treatment of giant keloid with surgery and non-surgery: A clinic study. Journal of Clinical Dermatology 2006, 35(4): 245-246.
49.	Jung JY, Roh MR, Kwon YS, et al. Surgery and perioperative intralesional corticosteroid injection for treating earlobe keloids: a korean experience. Ann Dermatol, 2009, 21(3): 221-225.
50.	Al Aradi IK, Alawadhi SA, Alkhawaja FA, et al. Earlobe keloids: a pilot study of the efficacy of keloidectomy with core fillet flap and adjuvant intralesional corticosteroids. Dermatol Surg, 2013, 39(10): 1514-1519.
51.	Madura C, Nayak PB, Raj PR, et al. Surgical approach in the management of ear keloids: our experience with 30 patients. Int J Dermatol, 2021, 60(12): 1553-1560.
52.	Hung YT, Lin SM, Tzeng IS, et al. Optimizing surgical outcome of auricular keloid with a novel multimodal approach. Sci Rep, 2022, 12(1): 3533. doi: 10.1038/s41598-022-07255-8.
53.	Zhang YG, Cen Y, Liu XX, et al. Clinical improvement in the therapy of aural keloids. Chin Med J (Engl), 2009, 122(23): 2865-2868.
54.	Park TH, Seo SW, Kim JK, et al. Earlobe keloids: classification according to gross morphology determines proper surgical approach. Dermatol Surg, 2012, 38(3): 406-412.
55.	Azzam EZ, Omar SS. Treatment of auricular keloids by triple combination therapy: Surgical excision, platelet-rich plasma, and cryosurgery. J Cosmet Dermatol, 2018, 17(3): 502-510.
56.	Valerón-Almazán P, Dehesa-García L, Vilar-Alejo J, et al. Surgical treatment of relapsing keloid of the pinna by fillet flap. Actas Dermosifiliogr, 2010, 101(3): 235-241.
57.	唐洁, 李小静, 唐悦玲, 等. 内剥切并局部注射治疗耳郭瘢痕疙瘩. 中国组织工程研究, 2014, 18(46): 7427-7431.
58.	Wu H, Dong G, Hu J, et al. Contour first-retrospective study of an algorithmic approach of auricular keloids. J Cosmet Dermatol, 2023, 22(4): 1304-1311.
59.	Seifert O, Bayat A, Geffers R, et al. Identification of unique gene expression patterns within different lesional sites of keloids. Wound Repair Regen, 2008, 16(2): 254-265.
60.	Syed F, Ahmadi E, Iqbal SA, et al. Fibroblasts from the growing margin of keloid scars produce higher levels of collagen Ⅰ and Ⅲ compared with intralesional and extralesional sites: clinical implications for lesional site-directed therapy. Br J Dermatol, 2011, 164(1): 83-96.
61.	Javad F, Day PJ. Protein profiling of keloidal scar tissue. Arch Dermatol Res, 2012, 304(7): 533-540.
62.	Jiao H, Zhang T, Fan J, et al. The superficial dermis may initiate keloid formation: Histological analysis of the keloid dermis at different depths. Front Physiol, 2017, 7: 8: 885.
63.	Tan KT, Shah N, Pritchard SA, et al. The influence of surgical excision margins on keloid prognosis. Ann Plast Surg, 2010, 64(1): 55-58.

1. Walliczek U, Engel S, Weiss C, et al. Clinical outcome and quality of life after a multimodal therapy approach to ear keloids. JAMA Facial Plast Surg, 2015, 17(5): 333-339.
2. 臧梦青. 增生性瘢痕和瘢痕疙瘩的诊治现状. 中华医学杂志, 2023, 103(7): 469-472.
3. Berman B, Maderal A, Raphael B. Keloids and hypertrophic scars: Pathophysiology, classification, and treatment. Dermatol Surg, 2017, 43 Suppl 1: S3-S18.
4. Ogawa R. The most current algorithms for the treatment and prevention of hypertrophic scars and keloids: A 2020 update of the algorithms published 10 years ago. Plast Reconstr Surg, 2022, 149(1): 79e-94e.
5. Ogawa R, Akaishi S, Dohi T, et al. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: effectiveness of the core excision method. Plast Reconstr Surg, 2015, 135(3): 868-875.
6. 李长青, 孙晋中. 核心摘除术加局部注射曲安奈德治疗瘢痕疙瘩36例. 中华烧伤杂志, 2008, 24(6): 465-466.
7. 钱维, 周牮, 范巨峰, 等. 扇形瘢痕组织瓣修复耳廓瘢痕疙瘩去核后创面. 中华整形外科杂志, 2016, 32(4): 268-271.
8. Luo S, Benathan M, Raffoul W, et al. Abnormal balance between proliferation and apoptotic cell death in fibroblasts derived from keloid lesions. Plast Reconstr Surg, 2001, 107(1): 87-96.
9. Supp DM, Hahn JM, Glaser K, et al. Deep and superficial keloid fibroblasts contribute differentially to tissue phenotype in a novel in vivo model of keloid scar. Plast Reconstr Surg, 2012, 129(6): 1259-1271.
10. Chong Y, Park TH, Seo Sw, et al. Histomorphometric analysis of collagen architecture of auricular keloids in an Asian population. Dermatol Surg, 2015, 41(3): 415-422.
11. Barnes LA, Marshall CD, Leavitt T, et al. Mechanical forces in cutaneous wound healing: Emerging therapies to minimize scar formation. Adv Wound Care (New Rochelle), 2018, 7(2): 47-56.
12. Harn HI, Ogawa R, Hsu CK, et al. The tension biology of wound healing. Exp Dermatol, 2019, 28(4): 464-471.
13. Huang C, Murphy GF, Akaishi S, et al. Keloids and hypertrophic scars: update and future directions. Plast Reconstr Surg Glob Open, 2013, 1(4): e25.
14. Ogawa R, Okai K, Tokumura F, et al. The relationship between skin stretching/contraction and pathologic scarring: the important role of mechanical forces in keloid generation. Wound Repair Regen, 2012, 20(2): 149-157.
15. De Sousa RF, Chakravarty B, Sharma A, et al. Efficacy of triple therapy in auricular keloids. J Cutan Aesthet Surg, 2014, 7(2): 98-102.
16. Conway H, Gillette R, Smith JW, et al. Differential diagnosis of keloids and hypertrophic scars by tissue culture technique with notes on therapy of keloids by surgical excision and decadron. Plast Reconstr Surg Transplant Bull, 1960, 25: 117-132.
17. Donkor P. Head and neck keloid: treatment by core excision and delayed intralesional injection of steroid. J Oral Maxillofac Surg, 2007, 65(7): 1292-1296.
18. Dong X, Mao S, Wen H. Upregulation of proinflammatory genes in skin lesions may be the cause of keloid formation (Review). Biomed Rep, 2013, 1(6): 833-836.
19. Lemperle G, Schierle J, Kitoga KE, et al. Keloids: Which types can be excised without risk of recurrence? A new clinical classification. Plast Reconstr Surg Glob Open, 2020, 8(3): e2582.
20. Apfelberg DB, Maser MR, Lash H. The use of epidermis over a keloid as an autograft after resection of the keloid. J Dermatol Surg, 1976, 2(5): 409-411.
21. Weimar VM, Ceilley RI. Treatment of keloids on earlobes. J Dermatol Surg Oncol, 1979, 5(7): 522-523.
22. Salasche SJ, Grabski WJ. Keloids of the earlobes: a surgical technique. J Dermatol Surg Oncol, 1983, 9(7): 552-556.
23. Lee Y, Minn KW, Baek RM, et al. A new surgical treatment of keloid: keloid core excision. Ann Plast Surg, 2001, 46(2): 135-140.
24. Kim DY, Kim ES, Eo SR, et al. A surgical approach for earlobe keloid: keloid fillet flap. Plast Reconstr Surg, 2004, 113(6): 1668-1674.
25. Suliman MT. The keloid fillet flap. Plast Reconstr Surg, 2005, 116(1): 337-338.
26. Liu S, Liang W, Song K, et al. Keloid skin flap retention and resurfacing in facial keloid treatment. Aesthetic Plast Surg, 2018, 42(1): 304-309.
27. Hao Y, Shan M, Liu H, et al. Clinical observation of subepidermal vascular network flaps in keloid patients. Aesthetic Plast Surg, 2022, 46(4): 2015-2022.
28. Ahmednaji NM, Wu XY, Wang YX, et al. Surgical core excision with tongue flap closure in combination with electron beam radiotherapy in the treatment of ear keloids. Dermatol Surg, 2023, 49(5S): S58-S63.
29. 李鹏程, 贾赤宇, 李月敏, 等. 手术联合术后即时放射治疗瘢痕疙瘩. 中华医学杂志, 2011, 91(45): 3223-3224.
30. Adams BB, Gloster HM. Surgical pearl: excision with suprakeloidal flap and radiation therapy for keloids. J Am Acad Dermatol, 2002, 47(2): 307-309.
31. Sun Q, Yu ET, Zhou Y, et al. Individualized surgery combined with radiotherapy and triamcinolone acetonide injection for the treatment of auricular keloids. BMC Surg, 2021, 21(1): 256.
32. Qi Z, Liang W, Wang Y, et al. “X”-shaped incision and keloid skin-flap resurfacing: a new surgical method for auricle keloid excision and reconstruction. Dermatol Surg, 2012, 38(8): 1378-1382.
33. Chen B, Wang X, Qi Z. Analysis of the surgical treatments of 63 keloids on the cartilaginous part of the auricle: Effectiveness of the core excision method. Plast Reconstr Surg, 2015, 136(4): 568e-569e.
34. Napoleone C, Giovannelli R, Capoccetti E, et al. Use of keloid cutis as reconstructive flap of the auricle after keloid excision. Plast Reconstr Surg, 2003, 111(1): 518-519.
35. Bednarek RS, Sequeira Campos M, Hohman MH, et al. Transposition Flaps. Treasure Island (FL): StatPearls Publishing, 2023..Bednarek RS, Sequeira Campos M, Hohman MH, et al. Transposition Flaps. Treasure Island (FL): StatPearls Publishing, 2023.
36. Memarzadeh K, Sheikh R, Blohmé J, et al. Perfusion and oxygenation of random advancement skin flaps depend more on the length and thickness of the flap than on the width to length ratio. Eplasty 2016, 16: e12. PMID: 26958105.
37. 武晓莉, 班耀林, 陈立彬, 等. “核心剥离式”瘢痕疙瘩修薄术联合放疗的疗效分析. 组织工程与重建外科, 2023, 19(1): 22-27.
38. 蔡震, 潘博, 游晓波. Fillet瓣联合术后磁铁片加压和曲安奈德注射治疗耳廓瘢痕疙瘩. 中华医学美学美容杂志, 2014, 20(2): 103-105.
39. Choi YJ, Lee YH, Lee HJ, et al. Auricular keloid management in Asian skin: Clinical outcome of intralesional excision and postoperative triamcinolone acetonide intralesional injection. J Cosmet Dermatol, 2020, 19(11): 3041-3047.
40. Imanishi N, Nakajima H, Minabe T, et al. Angiographic study of the subdermal plexus: a preliminary report. Scand J Plast Reconstr Surg Hand Surg, 2000, 34(2): 113-116.
41. Teng Y, Hao Y, Liu H, et al. Histology and vascular architecture study of keloid tissue to outline the possible terminology of keloid skin flaps. Aesthetic Plast Surg, 2022, 46(2): 985-994.
42. Liu Q, Wang X, Jia Y, et al. Increased blood flow in keloids and adjacent skin revealed by laser speckle contrast imaging. Lasers Surg Med, 2016, 48(4): 360-364.
43. Liang ZY, Wang YW, Hao Y, et al. Histopathologic study of keloid vascular structures shows the vascular origin pattern of keloid subepidermal vascular network flaps. Am J Transl Res 2023, 15(3): 1889-1896.
44. El-Kamel MF, Selim MK, Alghobary MF. Keloidectomy with core fillet flap and intralesional verapamil injection for recurrent earlobe keloids. Indian J Dermatol Venereol Leprol, 2016, 82(6): 659-665.
45. Sunohara M, Ozawa T, Harada T, et al. A technique for auricular keloid core excision using a skin biopsy punch. Aesthetic Plast Surg, 2012, 36(3): 628-630.
46. Cerejeira D, Bonito F, António AM, et al. A 7-year experience with keloid fillet flap and adjuvant intralesional corticosteroids. J Cutan Aesthet Surg, 2021, 14(2): 172-176.
47. Berman B, Bieley HC. Adjunct therapies to surgical management of keloids. Dermatol Surg, 1996, 22(2): 126-130.
48. Fang F, Zhao L, Wu XF, et al. Treatment of giant keloid with surgery and non-surgery: A clinic study. Journal of Clinical Dermatology 2006, 35(4): 245-246.
49. Jung JY, Roh MR, Kwon YS, et al. Surgery and perioperative intralesional corticosteroid injection for treating earlobe keloids: a korean experience. Ann Dermatol, 2009, 21(3): 221-225.
50. Al Aradi IK, Alawadhi SA, Alkhawaja FA, et al. Earlobe keloids: a pilot study of the efficacy of keloidectomy with core fillet flap and adjuvant intralesional corticosteroids. Dermatol Surg, 2013, 39(10): 1514-1519.
51. Madura C, Nayak PB, Raj PR, et al. Surgical approach in the management of ear keloids: our experience with 30 patients. Int J Dermatol, 2021, 60(12): 1553-1560.
52. Hung YT, Lin SM, Tzeng IS, et al. Optimizing surgical outcome of auricular keloid with a novel multimodal approach. Sci Rep, 2022, 12(1): 3533. doi: 10.1038/s41598-022-07255-8.
53. Zhang YG, Cen Y, Liu XX, et al. Clinical improvement in the therapy of aural keloids. Chin Med J (Engl), 2009, 122(23): 2865-2868.
54. Park TH, Seo SW, Kim JK, et al. Earlobe keloids: classification according to gross morphology determines proper surgical approach. Dermatol Surg, 2012, 38(3): 406-412.
55. Azzam EZ, Omar SS. Treatment of auricular keloids by triple combination therapy: Surgical excision, platelet-rich plasma, and cryosurgery. J Cosmet Dermatol, 2018, 17(3): 502-510.
56. Valerón-Almazán P, Dehesa-García L, Vilar-Alejo J, et al. Surgical treatment of relapsing keloid of the pinna by fillet flap. Actas Dermosifiliogr, 2010, 101(3): 235-241.
57. 唐洁, 李小静, 唐悦玲, 等. 内剥切并局部注射治疗耳郭瘢痕疙瘩. 中国组织工程研究, 2014, 18(46): 7427-7431.
58. Wu H, Dong G, Hu J, et al. Contour first-retrospective study of an algorithmic approach of auricular keloids. J Cosmet Dermatol, 2023, 22(4): 1304-1311.
59. Seifert O, Bayat A, Geffers R, et al. Identification of unique gene expression patterns within different lesional sites of keloids. Wound Repair Regen, 2008, 16(2): 254-265.
60. Syed F, Ahmadi E, Iqbal SA, et al. Fibroblasts from the growing margin of keloid scars produce higher levels of collagen Ⅰ and Ⅲ compared with intralesional and extralesional sites: clinical implications for lesional site-directed therapy. Br J Dermatol, 2011, 164(1): 83-96.
61. Javad F, Day PJ. Protein profiling of keloidal scar tissue. Arch Dermatol Res, 2012, 304(7): 533-540.
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耐甲氧西林表皮葡萄球菌合并PaproskyⅣ型股骨缺损的髋关节假体周围感染一例

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