Keloid scars can pose a difficult management problem. Whilst not harmful in themselves they can be cosmetically unappealing and lead to social embarrassment and resulting isolation, and following surgical excision they often reoccur. Mechanical pressure is an adjuvant to surgical treatment that has been found to have some efficacy. Ear pressure clips have been devised to allow constant pressure to be applied to external ear keloids. Previous efforts have used clips made from methylmetacrylate which are not pressure adjustable. The team in the Netherlands followed up 88 patients who were using an adjustable custom made pressure clip (for up to 12 hours a day for 6-18 months) following keloid scar excision surgery and assessed for recurrence of keloid and patient satisfaction using the POSAS scale. The recurrence rate was 29.5%, compared to other studies showing 10-20% recurrence rate, however the authors argue that their prolonged period of follow-up (mean 6.5 years compared to 23 months), and findings of late recurrences (at three years) explain this difference. Recurrence rates in darker skin tones were significantly higher, fitting with available literature on this condition. Patient opinion, comfort, appearance and openness for retreatment were all significantly higher in the non-recurrence group, although there was no statistically significant difference in compliance and duration of treatment. There was also a significant improvement in all POSAS scores before versus after treatment. Overall almost 50% had some discomfort and / or itching, but no serious complications were recorded, making this adjustable device superior in terms of avoiding pressure sores and necrosis. Despite the authors’ enthusiasm for custom-made clips, this device is expensive and time consuming to make. The appearance is unsightly, it needs to be applied for up to 12 hours a day and causes discomfort one wonders if this is likely to be an agreeable and acceptable solution for these patients. 

Efficacy of custom-made pressure clips for ear keloid treatment after surgical excision.
Tanaydin V, Beugels J, Piatkowski A, et al.
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Elinor Warner

MBBS MA (Oxon) MRCS DOHNS, Royal London Hospital; Vice-president WENTS, UK.

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