Tratamiento combinado de los queloides mediante cirugía y braquiterapia

Abstract

We present our experience in treatment of keloid scars with surgical resection and immediately postoperative radiotherapy. Radiotherapy changes keloid into an hypocellular, hypovascular and hypotoxic tissue, avoiding the excessive migration of fibroblasts. If the suitable dose of radiation is delivered, balance between the formation of the scar and the excessive proliferation of the tissue is achieved avoiding the formation of the keloid but keeping normal scarring. Our protocol is divided in two phases: the first one is the surgical treatment. The exeresis of the keloid is carried out through an incision that follows its own line and a careful closure in two planes; superficial one is always an intradermic suture. The second part will be radiotherapy, with two possible treatments: 1) Brachitherapy (treatment at a short distance), placing a catheter under the suture, through which a radioactive source is introduced, usually Ir192. It is used, specially in longitudinal wounds. 2) External radiotherapy with electrons of low energy. It is used in complex or large wounds. A dose of 20 Gy., in 4 fractions of 500 cGy, usually offers excellent results with minimum sequelae or side effects. The area to be irradiated should include the surgical wound, and a margin of 4 mm. around it. With this procedure, we have observed excellent results with a recidive rate lower tan 4% and an improvement in the clinical symptoms in 100% of cases. As a side effect, we have observed telangiectasies (15,4%) or changes in the cutaneous pigmentation (5,9%).