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      Combining micro-plasma radio-frequency with hypofractionated electron-beam radiation as a novel treatment of keloids : A case series

      case-report

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          Abstract

          Rationale:

          Micro-plasma radio-frequency (MPR) technology has been demonstrated a safe and effective treatment for kinds of scars, but there is no report about the application of the MPR on keloids. In this investigation, we creatively use MPR technology combining with hypofractionated electron-beam radiation to cure keloids.

          Patient concerns and Diagnoses:

          From February 2013 to December 2016, 22 Asian patients (16 male, 6 female, age 19–46 years, mean age 28.14 ± 7.31 years) with keloids over half a year were enrolled in this study.

          Interventions and Outcomes:

          All patients received a single MPR technology treatment by roller tip at 80–100 watt, and then hypofractionated electron-beam radiation of 6 MeV were performed twice, within 24 hours and one week after the operation with 9 Gy per time. Improvement were determined by the Vancouver Scar Scales (VSS) according to digital photographs. The results show that the volume of keloids reduced significantly among most patients. Only 3 patients encountered with mild to moderate hyperpigmentation, and none of malignance and worsening or recurrence of scars was observed.

          Lessons:

          MPR technology combined with post-operative hypofractionated electron-beam radiation therapy is an effective method for patients with multiple keloids distributed widely on the body with minimal complications, especially for patients with widely distributed keloids.

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          Most cited references20

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          Up-to-date approach to manage keloids and hypertrophic scars: a useful guide.

          Keloids and hypertrophic scars occur anywhere from 30 to 90% of patients, and are characterized by pathologically excessive dermal fibrosis and aberrant wound healing. Both entities have different clinical and histochemical characteristics, and unfortunately still represent a great challenge for clinicians due to lack of efficacious treatments. Current advances in molecular biology and genetics reveal new preventive and therapeutical options which represent a hope to manage this highly prevalent, chronic and disabling problem, with long-term beneficial outcomes and improvement of quality of life. While we wait for these translational clinical products to be marketed, however, it is imperative to know the basics of the currently existing wide array of strategies to deal with excessive scars: from the classical corticotherapy, to the most recent botulinum toxin and lasers. The main aim of this review paper is to offer a useful up-to-date guideline to prevent and treat keloids and hypertrophic scars.
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            Updated international clinical recommendations on scar management: part 2--algorithms for scar prevention and treatment.

            In 2002, an international advisory panel was convened to assess the scientific literature and develop evidence-based guidance for the prevention and treatment of pathologic scarring. Emerging clinical data, new treatment options, and technical advances warranted a renewed literature search and review of the initial advisory panel recommendations.
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              Postoperative electron-beam irradiation therapy for keloids and hypertrophic scars: retrospective study of 147 cases followed for more than 18 months.

              Between 1988 and 2000, 378 cases of keloids were treated in the authors' department, and 147 keloids in 129 patients were selected for this study. Keloids that occurred at a different site in the same patient and keloids that recurred later at the same site were deemed to be different keloids. Those keloids were surgically removed, and the patients were treated postoperatively with 15-Gy electron-beam irradiation and followed for more than 18 months. The therapeutic outcomes were evaluated. Statistical analysis was performed using Fisher's exact probability test or chi-square test. Recurrence occurred in two sites on 14 earlobes (14.3 percent), in two sites on 12 necks (16.7 percent), in 22 sites on 51 anterior chest walls (43.1 percent), in 13 sites in 33 scapular regions (39.4 percent), in four sites on 15 upper limbs (26.7 percent), in four sites in 11 suprapubic regions (36.4 percent), and in one site on 11 lower limbs (9.1 percent). The overall recurrence rate was 32.7 percent. Analysis of the therapeutic outcomes showed that the recurrence rates in the sites with high stretch tension, such as the chest wall, and the scapular and suprapubic regions were statistically higher than in sites without high tension, such as the neck, earlobes, and lower limbs (41.1 percent versus 13.5 percent, p = 0.0017). The results suggested that keloid sites with a high risk of recurrence should be treated with escalated radiation doses and posttreatment self-management.
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                Author and article information

                Journal
                Medicine (Baltimore)
                Medicine (Baltimore)
                MEDI
                Medicine
                Wolters Kluwer Health
                0025-7974
                1536-5964
                November 2019
                27 November 2019
                : 98
                : 48
                : e18094
                Affiliations
                Plastic and Reconstructive Surgery, Department of Plastic Surgery, Peking Union Medical College Hospital, Beijing, China.
                Author notes
                []Correspondence: Zhifei Liu, Division of Plastic and Reconstructive Surgery, Peking Union Medical College Hospital, No. 41 Damucang Hutong, Xicheng District, Beijing 100032, China (e-mail: 657753554@ 123456qq.com ).
                Article
                MD-D-19-04144 18094
                10.1097/MD.0000000000018094
                6890320
                31770227
                a4b27a5c-fb44-4b7c-b7d0-749f52b38ecd
                Copyright © 2019 the Author(s). Published by Wolters Kluwer Health, Inc.

                This is an open access article distributed under the Creative Commons Attribution License 4.0 (CCBY), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. http://creativecommons.org/licenses/by/4.0

                History
                : 31 May 2019
                : 07 October 2019
                : 24 October 2019
                Categories
                4000
                Research Article
                Clinical Case Report
                Custom metadata
                TRUE

                electron-beam radiation,keloids,micro-plasma,plasma skin regeneration,radio frequency

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