| Research Objective:Keloid is more common in plastic surgery and dermatology.Although it is a benign skin disease,it brings a series of physiological and psychological problems to the patients,and not only affects the appearance of the patients,it can also seriously affect the quality of patients'life,because of symptoms such as pain and itching or lower limb function.The treatment of keloid is still a difficult problem,At present,the most rapid and effective method is surgical resection,but the recurrence rate of simple surgical resection is extremely high,about 45%~100%,and the skin lesions after recurrence tend to increase compared with the previous ones.Radiotherapy can prevent hyperplasia of scar tissue,and postoperative radiotherapy is an effective treatment to prevent recurrence of keloid.At present,radiotherapy mainly includes superficial X-ray,?-ray,electron ray and so on.About postoperative radiotherapy of keloid,there is no uniform standard and the difference of clinical application is great.In this clinical study,electron irradiation was carried out in the operation area within 24 hours after operation,and the clinical effect was observed,which provided a reliable basis for the treatment of keloid.Research method:1.materialsFrom September 2015 to March 2018,50 Keloid patients,including 18 males and 32females,were selected from the Department of Burn and plastic surgery,Yantai Yuzhouding Hospital,affiliated to Qingdao University.There were 82 lesions,including25 in the ear lobe,4 in the auricle,22 in the chest wall,20 in the shoulder and back,4in the face and neck,4 in the lower abdomen,3 in the lower limb,mainly in the earlobe,the front chest,and the back of the shoulder.The size of the lesion was different,the maximum was 15cm x 8cm,and the minimum was 1cm x 0.5cm.2.Surgical proceduresSimple excision and suture:the wound is small and free of the subcutaneous tissue around the wound after the lesion is removed,and the suture of the whole layer is closed directly under the condition of little tension.Flap transfer:local rotation flap or propelling flap was used to repair the wound when there was tension in the suture.For the normal shape of the ear,the kernels were removed to preserve the scar epidermis.Skin graft:after the lesion was removed,When neither of the above methods can repair the wound,the wound can be covered by self-thickness or a skin graft.Operation requires complete removal of scar tissue,subcutaneous adipose layer,follow the tension-free suture and aseptic principle.3.Postoperative radiotherapyThe first time to receive radiotherapy within 24 hours after operation was 6 Mev electron rays,with a total dose of 14 Gy for 7 consecutive days,a single dose of 2 Gy,once a day.Research Results:In 82 cases of keloid,17 cases(14.7%)recurred and the recurrence rate was 20.73%.By?~2test,the recurrence rate was not related to the sex of the patient(?~2=0.04,P>0.05).The recurrence rate was correlated with the lesion site(?~2=8.601,P<0 05),the part with high tension was higher than the part with low tension,and there was no significant difference between the recurrence rate and the lesion site.The highest recurrenceratewasin theanteriorchest(8/22,36.36%),followedbythe shoulder(6/20,30.00%)and the ear(2/29,26.32%).The overall symptom improvement rate was 85.37%The satisfaction rate of the patients was 80.49%,and the degree of satisfaction was closely related to the clinical treatment results.Conclusion:Postoperative radiotherapy is a feasible method to prevent the recurrence of keloid,and the adverse reaction is light.The patient is satisfied with the treatment effect and is worthy of extensive use in clinical practice. |
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