Risk factors of recurrence after postoperative electron beam radiation therapy for keloid: Comparison of long-term local control rate.

AIM: To investigate the new risk factors for keloid recurrence after postoperative electron beam radiotherapy (RT) and evaluate the effectiveness of tranilast in combination with electron beam RT by comparing the local control rate. BACKGROUND: Identifying patients at high risk of recurrence after postoperative RT for keloids remains a challenge. Besides, no study examined the effectiveness of tranilast in combination with RT after surgery for the prevention of keloids recurrence. MATERIALS AND METHODS: This study included 75 lesions in 59 consecutive patients who had undergone postoperative RT at our institute. The follow-up period and prescription of tranilast were examined beside several potential risk factors, such as multiple lesions, size, and shape. RESULTS: The median follow-up was 72 months (range, 6-147 months). Twenty-one lesions in 17 patients recurred in a median of 12 months after treatment (range, 1-60 months). Local control rates of all 75 lesions were estimated as 93%, 78%, 70%, and 68% at 1, 2, 5, and 10 years. Multiple lesions constituted a significant risk of recurrence (P = 0.03). A larger long axis was significantly related to the recurrence (P < 0.01). Irregular shape was associated with a significantly worse local control rate (P = 0.02). There was no significant difference in the local control rate between patients receiving tranilast and those who did not (P = 0.52). CONCLUSIONS: Multiple lesions and irregular shape were risk factors of keloid recurrence after postoperative electron beam RT. The effectiveness of tranilast was not demonstrated in the study.

Analyses of size and computed tomography densitometry parameters for prediction of keloid recurrence after postoperative electron beam radiation therapy.

BACKGROUND: The lesion size is a risk factor for keloid recurrence after postoperative radiotherapy. However, it remains unclear whether the major axis diameter is the most appropriate parameter to evaluate lesion size, because keloids are often irregular in shape. Additionally, no previous study has investigated computed tomography (CT) densitometry parameters of keloids as potential predictors for recurrence after postoperative radiotherapy. MATERIALS AND METHODS: The size and CT densitometry parameters were measured for 74 lesions with CT images of sufficient quality for evaluation. The association between recurrence and size or CT densitometry parameters was analyzed for 64 lesions that could be followed up for 6 months or more. RESULTS: The major axis diameter × minor axis diameter × thickness showed the strongest correlation with volume (ρ = 0.96, P < .0001). The median follow-up period was 71 months, and 17 lesions recurred. The major axis diameter × minor axis diameter × thickness ≥2.5 cm3 (hazard ratio = 5.9, P = .0052) and volume ≥1.2 ml (hazard ratio = 4.3, P = .029) were significantly associated with keloid recurrence under multivariate analyses, while the major axis diameter alone were not. The mean and maximum CT values, and the kurtosis and skewness of density histogram were not significantly different between recurrent and non-recurrent lesions. CONCLUSION: The major axis diameter × minor axis diameter × thickness may be a better parameter than the major axis diameter alone. CT densitometry analyses may not help to predict keloid recurrence after postoperative electron beam radiotherapy.

Validity of exploration for suitable vessels for replantation in the distal fingertip amputation in early childhood: replantation or composite graft.

Composite grafting, grafting without microvascular anastomoses, has been widely performed for distal fingertip amputation in children with variable results, whereas successful replantation of these amputations using microsurgical technique has been reported. However, most of these reports included a wide age-range and a mix of different amputation levels. This study reviewed our cases of paediatric digital amputation, in order to verify the value of distal fingertip replantation over composite grafting, especially in early childhood. Seventeen young children (aged 3 years and 8 months on average), with single-digit fingertip amputations in Tamai zone I were reviewed from 1993-2008. Each amputation was subdivided into three types: distal, middle, and proximal. There were three distal, 13 middle, and one proximal type zone I amputations. All were crush or avulsion injuries. All three distal-type cases were reattached as primary composite grafts with one success. For middle-type cases, the survival rate of primary composite graft without exploration for possible vessels for anastomosis was 57%. On exploration, suitable vessels for anastomosis were found 50% of the time, in which all replantations were succeeded. The remaining cases were reattached as secondary composite grafts, with one success using the pocket method. Consequently, the success rate after exploration was 67%. The only one proximal-type amputation was failed in replantation. For the middle-type zone I amputation in early childhood, replantation has a high success rate if suitable vessels can be found. Therefore, exploration is recommended for amputations at this level with a view to replantation, irrespective of the mechanism of injury.

Successful management of tracheoinnominate artery fistula using a split pectoralis muscle flap with anatomical reconstruction by a synthetic graft.

We report the successful repair for tracheoinnominate fistula, in which the innominate artery was interposed with a synthetic graft and the pectoralis muscle was used as a seal against infection. We know of 10 other reported cases.