Use of a collagen-glycosaminoglycan copolymer (Integra) in combination with adjuvant treatments for reconstruction of severe chest keloids.
BACKGROUND
Keloids occurring on the chest can be deforming with significant painful sequelae for patients. These lesions can pose a therapeutic dilemma for the dermatologic surgeon as certain excision defects may be too large to close primarily and recurrences tend to be high (40-100%). A collagen-glycosaminoglycan copolymer (Integra) has been found to be useful in the surgical treatment of scar excisions as the bovine collagen and glycosaminoglycans provide a template for neocollagenesis. Additionally, this dermal regeneration template concomitantly reduces tensile forces on the wound.


METHODS
The authors' group has followed five patients with chronic chest keloids refractory to myriad of interventions and treated these patients with surgical excision followed by Integra placement into the wound bed on the chest. Split-thickness grafts were applied shortly thereafter. Patients were followed at regular intervals and all patients received adjuvant therapy with single-dose radiation and intralesional chemotherapy (triamcinolone and/or 5 fluorouracil).


RESULTS
This treatment protocol has provided a cure rate of 100% over an average of 43 months follow-up. The symptoms often accompanied by these chest keloids also appear to improve.


CONCLUSIONS
The authors believe that this study provides the groundwork for further investigation of Integra for surgical management of keloids. A placebo-controlled study should be performed to adequately determine if this data holds true.
Davison
Steven P
SP
DAVinci Plastic Surgery, Washington DC 20016, USA.
Sobanko
Joseph F
JF
Clemens
Mark W
MW
D000328:Adult; D000368:Aged; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000627:therapeutic use; D002809:Chondroitin Sulfates / Q000008:administration & dosage*; D002908:Chronic Disease; D003094:Collagen / Q000008:administration & dosage*; D003131:Combined Modality Therapy; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage / Q000627:therapeutic use; D005500:Follow-Up Studies; D006801:Humans; D007627:Keloid / Q000473:pathology / Q000628:therapy*; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012720:Severity of Illness Index; D013909:Thorax / Q000473:pathology; D016896:Treatment Outcome; D014221:Triamcinolone / Q000008:administration & dosage / Q000627:therapeutic use
D000893:Anti-Inflammatory Agents; C114835:integra artificial skin; D014221:Triamcinolone; D002809:Chondroitin Sulfates; D003094:Collagen; D005472:Fluorouracil