Brief Answer:
Yes,you may go for surgical treatment as this keloids are widespread.

Detailed Answer:
Hello,
welcome to HCM.

I have read your query and have gone through both the images you uploaded.

Keloids occur due to excessive formation of scar tissue as part of the wound healing process. They are actually raised above the surface unlike normal scaring which is flat/level with the skin.

Keloids are also usually itchy and may extend beyond the actual wound margins with finger like projections.

Considering your large keloids,yes you can go for surgical excision of those hypertrophied keloids/scars followed by radiation treatment of the area or steroid injections must be given to prevent recurrence.As you have already tried steroid injections/creams/tablets since many years.

Without another treatment, there is high chances of recurrence rate of keloids after surgical excision.

In some cases,steroids are used to soften the keloids,decrease the amount to be removed, prepare the area for excision, and hopefully prevent recurrence after excision.

You can make appointment with plastic surgeon who will better know about it.

Hope this will help you.

Regards,

Dr.Sandip Kabra

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Brief Answer:
Recurrence rate is high even after surgery or laser treatment.

Detailed Answer:
Hello,
Thanks for the reply.

1) Simple excisional surgery involves the least amount of soft tissue handling to minimize trauma and to close with minimal skin tension.

Both full and split thickness skin grafts is used to reduce wound tension,so that it can be healed easily but these have been only partially successful because the chances of recurrence is high as the tendency of keloid formation is difficult to eliminate.Generally it will require 1 or 2 day hospitalization.

2) Laser therapy:

The advantage of laser therapy is that it is a precise, hemostatic excision of tissue with minimal tissue trauma, thereby eliminating an excessive inflammatory reaction.It is a day care procedure and most probably does not require hospitalization.

The different modes of laser therapy are,

i) flash lamp pulse-dyed laser,
ii) carbon dioxide laser,
iii) argon laser, and
iv) the Nd:YAG laser.

The carbon dioxide laser and argon laser work by similar mechanisms (by inducing collagen shrinkage through the laser heat).

The pulse-dyed laser induces micro-vascular thrombosis, and the Nd:YAG laser appears to selectively inhibit collagen metabolism and production.

Also it requires number of sessions to get rid off keloids and the chances of recurrence is more than 90%.

If keloids are painful and pus oozing then you may need to apply topical antibiotics like moxifloxacin (brand name moxicip cream or ointment) over keloids and oral antibiotic like cefixime 200 mg course after consulting dermatologist.

Once the infection is controlled,intralesional steroids can be given followed by excision surgery/laser treatment.

So,better to consult dermatologist or cosmetic surgeon.

I am sorry that I practice in Ahmadabad far away from XXXXXXX so I personally do not know any plastic surgeon in XXXXXXX

Regards,

Dr.Sandip

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