Scar revision

Keloid Management

It is well known that the risk of keloid rebound following scar revision is very high. The patient not only has to endure the physical problems of painful and sensitive scars, but also the significant psychological impact, especially if the scar is located in a prominent area such as the ears.
Ear Keloids

Treatment of ear keloids is notoriously difficult and usually involves the use of a Zimmer splint, or clip on earrings. This method is problematic and is only of limited use, if the keloid is located on the ear lobe. With a fashion trend for both males and females having piercings to the upper aspect of the ear, resulting keloids would be impossible to treat using the above method.

The problem of location also presents itself with the development of keloid scarring to the post auricular area following pinnaplasty. A child who has undergone pinnaplasty to change their cosmetic appearance, only to suffer large scar formations resistant to available treatments, can experience severe psychological impact.

This close-up image shows the precision fit which can be achieved using our technique and materials. As the image shows, the split fits closely to all of the undercuts and details of the ear.

Keloid Splint

The use of pressure to treat keloid scarring is far from new and custom made splints have been in use for some time. These are usually opaque, of oyster type design, with nuts and bolts used to secure the splint in place.

One of the main problems with these splints, is that when the patient presents with a keloid scar, it is already well established and, as a consequence, unlikely to respond to the limited available treatments.

After Treatment

Surgical scar revision of keloids is commonplace, but the risk of rebound can be in excess of 80%. We have studied this problem for some time and have come to the obvious conclusion that no one treatment method, or approach, works.

We have, over the past few years, developed a treatment protocol that has proved successful. This follows a timeline approach.

Treatment Timeline

1. Good patient selection as compliance with the protocol is key.
2. The use of intralesional steroid injections in an attempted to reduce scar activity.
3. Planned surgical debulking of the keloid.
4. Follow up 7 – 10 days following surgery to allow swelling to reduce.
5. At this time an extremely accurate impression is taken of the ear/ears.
6. Fabrication of a custom made splint using quality materials and new design.
7. Patient is fitted with splint 5 days later.
8. Patient also begins use of silicone gel or sheeting as directed.
9. Patient is reviewed after 7 days to monitor for pressure issues and compliance.
10. Patient continues to be monitored and treatment adjusted as required
11. Splint may need to be worn for up to 1 year.

After step three, CM Prosthetics will take over the treatment process. The patient only needs to see the consultant again if there is a need for intralesional steroids to be used. The consultant will be sent reports and photographs to keep them updated.

The use of this protocol will not offer a 100% success. However, we feel that, if each step is followed, the risk of scar rebound is drastically reduced. The use of our unique custom made splint is very well tolerated by the patient.

We have overcome the problem of tissue necrosis that other splint designs suffer from by the use of a clear acrylic. As stated above, the use of splintage in the treatment of keloids is far from new. However, existing designs are poor and the use of Zimmer Splint is stone age! Most patients present with an active keloid and it is therefore very unlikely that splintage will be of any use. Planning is the key.



What is a prosthesis?


A prosthesis is an artificial substitute for a missing part of your body.

Medical prostheses artificially restore patients who have facial or body defects due to malignancy, congenital deformity, or trauma. They offer hope to patients who cannot be surgically reconstructed and are used as a temporary measure for patients who are awaiting surgical reconstruction.

In order for the prosthesis to appear life like, every texture, form and pigmentation must be carefully matched. This requires several clinic visits as well as extensive laboratory work.


Aftercare

Our Services


CM Prosthetics provide specialist prosthetic services to both the National Health Service and the independent sector.




What care will my prosthesis need?


The type of care needed will depend on the materials used and the type of prosthetic.

Once we have fitted your new prosthesis we will supply you with all the information you need to care for it. We will also arrange for a follow-up appointment, to ensure that there are no problems with your prosthesis and that you are completely happy.


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