Keloid Skin Flap Retention And Resurfacing In Facial Keloid Treatment And HBO Therapy Reverse The EMT In Keloid

Objectives Facial keloids commonly occur in young patients.Multiple facial keloid masses converge a large area of the face,representing a significant obstacle to keloid mass excision and reconstruction.In previous study,it has been demonstrated that hypoxia/hypoxia-inducible-factor-1α(HIF-1α)microenvironment provided a favorable environment of keloid-derived keratinocytes transformed into fibroblast-like cells through Epithelial-to-Mesenchymal Transition(EMT)phenomenon.In clinical works,hyperbaric oxygen(HBO)therapy has been used in the treatment of challenging wounds and selected neurological diseases.In the plastic field,HBO therapy is also regarded as a successful adjunctive therapy for promoting wound healing,reducing inflammatory reaction and improving flap survival.We describe a new surgical method that excises the keloid mass and resurfaces the wound by saving the keloid epidermis as a skin flap during facial keloid treatment.And we detect the hyperbaric oxygen therapy(HBOT)with the EMT of keloid.Methods 1 Eighteen recurrent keloid tissue(9 with HBOT,another 9 without HBOT)and 9 normal skin tissue were collected.Hematoxylin and eosin(H&E)staining was used to observe morphology.E-cadherin,ZO-1,Vimentin,Fibronectin,VEGF and HIF-1α of three groups were measured by immunofluorescence staining and western blot technology.Real-time quantitative polymerase chain reaction(RT-q PCR)was used to evaluate the m RNA expression level of factors above.2 Facial keloids were treated in our department between February 2016 and February 2018.Multiple incisions smaller than the keloid were made along the facial esthetic line on the keloid mass.The keloid epidermis was dissected with minimally invasive dissection and scar tissue in the keloid was removed through the incision.The wound was covered with the preserved keloid epidermis skin flap and closed without tension.Radiotherapy was applied after surgery.Hyperbaric oxygen therapy was applied before and after surgery.Patients underwent follow-up examinations 6 and 12 months after surgery.Results 1 Compared to the K group,lower expression levels of Vimentin,Fibronectin,VEGF and HIF-1α were observed in the O group,whereas E-cadherin and ZO-1 expression was significantly higher(P<0.05).2 Eighty-two patients were cured and 25 patients were partially cured out of the 120 total patients.The efficacy rate was 89.2%,and 102 patients(85.0%)were satisfied with the esthetic result.Conclusions 1 The expression levels of EMT-phenomenon-related factors were significantly reversed in the samples from keloid patients after receiving HBO therapy,which indicating that HBO therapy may become one effective therapy against EMTphenomenon in keloid patients.2 We describe an efficacious and esthetically satisfactory method for managing facial keloids by preserving the keloid epidermis as a skin flap.