Punch Excision Combined With Radiotherapy for Keloid Treatment

BACKGROUND: Punch excision is gaining recognition in keloid management. Its distinct mechanism from conventional surgery necessitates a re-evaluation of the efficacy and safety when combined with radiotherapy (RT), an area currently lacking evidence. AIMS: To investigate the clinical efficacy and safety of punch excision combined with RT for treating trunk keloids and to compare the differences between perioperative (RT initiated one day before surgery) and postoperative RT (RT within 24 h after surgery) regimens. METHODS: A retrospective study was conducted on patients with trunk keloids treated with punch excision combined with electron beam RT from January 2022 to January 2024. Outcomes were assessed using the Patient and Observer Scar Assessment Scale (POSAS) and records of adverse reactions. RESULTS: The study included 34 patients. At 18 months, all keloids improved significantly without recurrence. The total Observer Scale score decreased by 52.73% and the Patient Scale score by 62.77%. No significant difference in POSAS scores was found between the two groups at 18 months. The perioperative group showed advantages in shorter postoperative bleeding duration and lower incidence of moderate-to-severe acute pain. CONCLUSION: Punch excision combined with RT is effective for trunk keloids. While long-term cosmetic outcomes are similar between perioperative and postoperative RT, the perioperative regimen offers benefits in reducing early postoperative complications.