| Background:A keloid is defined as an overgrowth of pathological scar tissue that grows beyond the original boundaries of the wound,does not regress spontaneously and tends to recur despite treatment.Keloid not only affects the appearance,but also impacts on patient quality of life and functional status.The current clinical treatments for keloid mainly include surgical treatment,corticosteroids local injection,laser therapy,radiotherapy,cryotherapy,local compression,scar silicone,etc.Despite the number of methods available,single therapy can hardly achieve ideal therapeutic outcome and treatment of relapsed and refractory remains a challenge.Individual and comprehensive treatment has become the trend of keloid treatment.Dynamic evaluation and the combined application of multiple treatment methods have formed a comprehensive dynamic treatment model for keloid,which has gradually become the main treatment of keloid.In recent years,with the in-depth study of the pathogenesis of keloid,new treatment methods have been improved,such as pulsed dye laser.PDL which was originally used in skin vascular diseases,has been gradually applied to the comprehensive dynamic treatment mode of keloid,and achieved certain therapeutic effects.Keloid tissue is different from skin vascular disease,and it has its own particularity.Thus the application and clinical efficacy of PDL in the comprehensive dynamic treatment of keloid need more clinical verification.Objective:This study retrospectively analyzed the clinical data of patients who received conservative treatment treated in our department in recent years.The purpose of this study is to analyze the efficacy and specific advantages of different treatments and to provide some ideas and methods for the treatment of keloid.This study retrospectively analyzed the clinical data of patients with keloid who received conservative and surgical treatment in our department in recent years.And discussing the reasonable application and usefulness of PDL in the comprehensive dynamic treatment mode of keloid by analyzing the application mode and curative effect of PDL in order to provide a new treatment for keloid.Methods:A retrospective analysis was made on the patients diagnosed as keloid and treated with conservative treatment treated by plastic and reconstructive surgery in * Hospital of * University from April 2015 to October 2020.According to the inclusion and exclusion criteria,34 patients(46 keloids)with non-operative treatment were finally selected,including 14 males and 20 females.The patients were divided into two groups according to different treatment methods: group A1: triamcinolone acetonide injection group(18cases,26 keloids);group B1: 595 nm pulsed dye laser combined with triamcinolone acetonide injection group(16 cases,20 keloids).A total of 36 patients(48 keloids)with recurrence after surgical treatment were finally selected,including 8males and 28 females.The patients were divided into two groups according to different intervention methods: A2: triamcinolone acetonide injection group(21cases,29 keloids);group B2: 595 nm pulsed dye laser combined with triamcinolone acetonide injection group(15 cases,19 keloids).At each follow-up,two plastic surgeons who were not involved in the treatment used the Vancouver Scar Evaluation Scale,the Patient and Observer Scar Score Scale,and the Dermatological Quality of Life Index to evaluate the treatment effect,and record the patient’s general information and treatment Program and evaluation of efficacy.The differences in the scores of the various scales before and after treatment and the differences between the A1 and A2 groups and the differences between the B1 and B2 groups were compared.Result:Non-operative treatment group:1.Effects of different treatment modes of treatment on keloid: The scores of VSS,DLQI and POSAS in the two groups were significantly improved compared with those before treatment(p<0.05).However,there was no significant difference in the scores of VSS,POSAS and DLQI between the two groups before and after treatment(p >0.05).2.Comparison of different treatment modes of treatment on keloid: The markedly effective rate in group B1 was higher than that in group A1,and the difference was statistically significant(p < 0.05).The average injection times and effective time in group B1 were lower than in group A1,and the difference was statistically significant(p < 0.05).3.Effects of different treatment modes on compliance of patients with keloid: The number of follow-up in group B1 was higher than that in group A1 in the first year of treatment(p < 0.05).4.Effects of different treatment modes on side effects of keloid: The incidence of complications in group B1 was significantly lower than that group A1(p < 0.05).For the adverse reactions of telangiectasia,the incidence of telangiectasia in group B1(10%)was lower than that in group A1(26.92%),but there was no statistical difference.Postoperative recurrence group:1.Comparison of VSS scores between the two groups before and after dynamic evaluation: VSS scores in group A2 and B2 were improved after treatment,and VSS scores in group B2 were lower than those in group A2 after treatment(p > 0.05).2.Comparison of pigmentation and vascularity scores between the two groups before and after dynamic evaluation: the total scores of pigmentation and vascularity in group A2 and B2 after treatment were significantly lower than those before treatment(p < 0.05),and the total scores of pigmentation and vascularity in group B2 were significantly lower than those in group A2(p < 0.05).3.Efficacy evaluation of the two groups before and after comprehensive treatment: the markedly effective rate in group B2(94.74%)was higher than that in group A2(75.86%),but the difference was not statistically significant(p > 0.05).Conclusion:1.Pulsed dye laser combined with local injection can reduce the number of injections,shorten the effective time,increased the number of follow-up in the first year of treatment and increased the compliance of patients in patients with non-operative keloid compared with local injection alone.2.In the postoperative dynamic follow-up evaluation,the reasonable application of pulsed dye laser combined with local injection can effectively control the recurrence,stabilize the condition and achieve a relative cure. |
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