title: Efficacy of triple therapy in auricular keloids.
abstract: BACKGROUND
  Keloids are characterised by their continued growth following trauma, extension into normal tissue and their high recurrence rate following excision. Auricular keloids are common following ear piercing or flame burns. These lesions are highly conspicuous and cosmetically unappealing. Multiple methods including surgery, radiotherapy, antimitotic agents, silicone sheet, pressure clips and cryotherapy have been advocated. The risk of recurrence and the need to prevent distortion of the three-dimensional structure of the ear following resection is a challenge to the cutaneous surgeon.
  
  
  OBJECTIVE
  To devise a standard protocol for management of auricular keloids with minimal distortion and recurrence.
  
  
  METHODS
  The patients underwent day-care surgery and subsequent out-patient follow-up for a minimum period of 1 year.
  
  
  METHODS
  Ten patients presenting with 22 ear keloids were enrolled into a keloid protocol: (a) surgical excision and keloid rind flap cover with (b) intra-operative and post-operative intra-lesional steroid and (c) silicone sheet application. Subjective assessment on follow-up was using Patient Observer Scar Assessment Scale and objective assessment was by Beausang scale.
  
  
  METHODS
  Microsoft Excel and Statistical Package for the Social Sciences (SPSS). Kaplan-Meier survival analysis curve used to calculate Recurrence Free period.
  
  
  RESULTS
  Two out of 22 (9.1%) keloids developed post-excision recurrence after a mean follow -up period of 16 months. The average keloid recurrence free interval was 21 months.
  
  
  CONCLUSIONS
  Triple combination therapy for keloids on the ear is a simple technique for management with preservation of contour of the ear and a low recurrence rate.
authors.affiliation: Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: Reuben F
authors.initials: RF
authors.lastname: De Sousa
authors.affiliation: Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: Bijitesh
authors.initials: B
authors.lastname: Chakravarty
authors.affiliation: Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: Alok
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: M Alam
authors.initials: MA
authors.lastname: Parwaz
authors.affiliation: Department of Plastic Surgery, Armed Forces Medical College, Pune, Maharashtra, India.
authors.forename: Anil
authors.initials: A
authors.lastname: Malik
keywords: Auricular keloid; intra-lesional steroid; keloid recurrence; keloid rind flap; triple combination therapy