Analysis of the Surgical Treatments of 63 Keloids on the Cartilaginous Part of the Auricle

Sir: We read the article entitled “Analysis of the Surgical Treatments of 63 Keloids on the Cartilaginous Part of the Auricle: Effectiveness of the Core Excision Method,” by Dr. Ogawa et al.,1 with great interest. The ear is the most common site for keloid, and this technique is suitable for our patients, not only because of its good cosmetic effect but also because of its lower recurrence rate combined with adjuvant treatment. We have been using it since 2005 with good results and low recurrence so far.2 To prevent flap ischemia, we design an X-shaped incision and a four-keloid skin flap, compared with the authors’ two-keloid skin flap. In our department, radiotherapy is applied on the first and seventh postoperative days (900 cGy each time). We are interested in the harmony between the vascularity of a flap and radiotherapy. We would appreciate it if the authors could share their experience. As stated by the authors, one group consisted of keloids that were treated by total excision methods before 2009, whereas the other group of keloids were treated by the core excision method after 2009, regardless of size. In the authors’ opinion, the total excision method should be more suitable for narrow and small keloids; however, it leaves a wound that can be closed with high tension to large keloids. We quite agree with this opinion. However, in the article, we do not find a description regarding the size of keloids.1 As we know, this operation is usually performed by junior physicians, and the technology available to junior physicians usually undergoes great improvement in those years. Does this improvement of suture technology have some influence on the recurrence and cosmetic effect? Lee et al.3 had reported the core excision method for keloids of the ear (n = 14), trunk (n = 4), face (n = 4), and genitalia (n = 2). Kim et al.4 used a keloid fillet flap for the earlobe keloids. We quite agree with Dr. Ogawa regarding the suitability and high success of this method in treating auricle keloids, and we think more trials should be conducted to attempt use of it on other parts of the body. DISCLOSURE None of the authors has a financial interest in any of the products, devices, or drugs mentioned in this communication. Bo Chen, M.D. Xiaojun Wang, M.D., Ph.D. Zheng Qi, M.D. Department of Plastic and Reconstructive Surgery Peking Union Medical College Hospital Beijing, People’s Republic of China