Should a Tissue Cuff Be Preserved During Auricular Lobule Keloid Excision to Reduce Recurrence?

Area of Science:

• Dermatology
• Plastic Surgery
• Surgical Oncology

Background:

• Keloids of the auricular lobule are challenging to manage, with frequent recurrence after excision.
• Traditional core excision preserves peripheral keloid tissue to minimize recurrence and allow low-tension closure.
• Recent evidence questions preserving keloid tissue, suggesting it may promote recurrence.

Purpose of the Study:

• To review current evidence on managing auricular lobule keloids.
• To evaluate the efficacy of different surgical techniques and adjuvant therapies.
• To provide evidence-based recommendations for keloid management.

Main Methods:

• Systematic review of histopathologic and clinical studies.
• Analysis of evidence regarding core excision versus complete excision.
• Evaluation of adjuvant therapies, including corticosteroid injections.

Main Results:

• No universal approach is supported by current evidence.
• Complete excision with tension-minimized closure is suitable for small to medium keloids.
• For large keloids, cuff-preserving excision, staged excision, or stellate excision may be considered, alongside adjuvant therapy.

Conclusions:

• Management strategies for auricular lobule keloids should be individualized.
• Adjuvant therapies, especially serial corticosteroid injections, are crucial postoperatively.
• Further research is needed to optimize surgical techniques and adjuvant combinations.