What is Keloid?
Keloid is an abnormal wound healing. Physiologically, wounds heal within a few weeks. With the help of the proteins called collagen, the wound becomes firmer and the resistance increases. It is the collagen that provides it. A scar occurs after the wound heals. The size of the scar is determined from the region to the region, type of injury, tension and other reasons. Keloid is characterized by an extremely large scar, this scar goes out of the wound area and cause an unpleasant image.
What Causes Keloid?
While the wound is recovered, collagen usually decreases its production after 3 weeks and the wound begins to heal. In Keloid, collagen production never stops and the wound is not healed. This collagen production continues despite the healing of the wound, this period can last for years. Keloid is usually genetic, but the exact cause is unknown. Sometimes severe injuries, severaly burned wounds, cause similar scarring, but they are different from keloid and are easier to treat. These are called hypertrophic scars and are within the limits of the original wound. Keloid goes beyond these limits.
All kinds of injuries that may occur in genetically predisposed persons (cuts due to injury, scratches, surgical incisions, needle stings, vaccinations, tattoos, earrings, piercings) may cause cancer.
As a result, keloid may occur as a result of any trauma that disrupts skin integrity.
Most vulnerable Areas
- Breast area,
- Above the joints,
Keloid formation can be seen in every part of the body. However, some people may have it one some part of the body and don’t have it at the other parts.
Since keloid is caused by uncontrolled production of collagen, collogen-suppressing drugs such as steroid can be injected into the lesion and keloid can be controlled.
Printed clothing can also reduce the keloid.
In fact, keloid can be removed and treated very easily wherever it is in the body. However, since there is wound healing disorder in the pathophysiology of keloid, collagen production is more intense after surgery and the rate of keloid reappearing greater than before surgery and is almost 100%. Therefore, after the removal of koloid tissue additional intervention is required. Steroid injection and wearing printed clothing are some of the procedures that must be performed after the surgery.
Keloid And Brachytherapy
For many years, keloid treatment has not been successful. After the surgery, the application of radiotherapy has provided successful results. However, it has always been avoided because of the carcinogenic effect of radiotherapy on the body. When radiotherapy is applied, it has a negative effect on other parts of the body except the lesion site.
In recent years, with the help of special devices which are used with the technique called brachytherapy, the radiation beam can only be used in the keloid area and in low doses.
After surgical removal of the keloid tissue, special tubes placed in the surgical area. The tubes remain in the scar area and the tip of the tubes is left outside the wound site. Within the first 8 hours after the operation, a very low dose of radiation beam is passed through the tubes. Since this beam passes through the protected area and the dose is low, it does not spread to another part of the body. It only affects the scarred area. The amount of radiation that can spread out is far below the rates that can damage the body. Depending on the size of the lesion, the dose of radiation is determined and a few more doses are completed within a few days. At the end of the treatment, the tubes are withdrawn from the surgical area.
In this process, the wound healing continues and over-production is stopped because collagen is suppressed.
Recent studies have shown that 50% to 80% of keloid patients treated with brachytherapy and keloid have not been reappeared.
I have keloid formation due to genetic reasons. I want to have surgery and I have seen you have successful results in this regard, but would the keloid that disappeared after surgery reappear in the same area?
Keloid is a wound-healing disorder. For this reason, the keloid may occur in the same area in the healing process. Therefore, additional treatments should be done to prevent the recurrence of keloid. With the brachytherapy procedure, the application of low dose beam therapy to the surgically removed keloid, 70-80% successful results can be obtained.
Do use local or general anesthesia in keloid surgery?
Keloid treatment consists of two stages. Immediately after the surgical procedure in a sterile environment, patients are directed to the beam therapy. For this reason, it is a procedure preferably to be performed under local anesthesia. However, keloid surgery can be performed under general anesthesia.
I have heard that it may be possible to stop the increase in collagen during the keloid surgery. If I encounter such a problem, how many times do I need to have surgery in the same area to fix this?
Depending on the area where the keloid is located, a success rate of 70-80% can be achieved in keloid surgery. However, the keloid may recur even if it is unlikely. When such a situation is encountered, the brachytherapy procedure can be repeated.
Can the dose of radiation in the Keloid treatment be miscalculated? If so, what could be the consequences?
Before keloid treatment, dose adjustment is carefully made by experienced physicians. At the same time, the radiation to be used does not affect any area other than the wound area, since it is applied in very low doses and through a tube.
How long does the Keloid surgery take? Is there anything I should pay attention to after the surgery? If so what are they?
Keloid surgery takes 30-60 minutes depending on the size and number of the keloid. Things to pay attention to after the procedure will be carefully explained to the patient by the surgeon.