The purpose of this study was to investigate the efficacy of surgery combined with triamcinolone acetonide injection in managing the difficult problem of keloid formation after syndactyly release. Twenty-two patients with keloid formation after syndactyly release were retrospectively reviewed. They were divided into a simple surgery group and a surgery plus injection group. Complications, web quality, scar score and satisfaction were assessed and compared. In the surgery plus injection group, three patients (3/13) experienced recurrence and ten webs were good, whereas in the simple surgery group, seven patients (7/9) experienced recurrence and five webs were poor. The mean Vancouver Scar Scale score was significantly lower (4.3 versus 7.8) and the mean Faces Questionnaire satisfaction score was higher (4.2 versus 2.6) in the surgery plus injection group. Combining surgical excision with early and repeated intralesional injection can achieve better results with low recurrence rate and side effects.
Al-AttarAMessSThomassenJMKauffmanCLDavisonSP.Keloid pathogenesis and treatment. Plast Reconstr Surg. 2006,
117: 286–300.
2.
BaryzaMJBaryzaGA.The Vancouver Scar Scale: an administration tool and its interrater reliability. J Burn Care Rehabil. 1995,
16: 535–8.
3.
D'ArcangeloMGilbertAPirrelloR.Correction of syndactyly using a dorsal omega flap and two lateral and volar flaps: a long-term review. J Hand Surg Am. 1996,
21: 320–4.
4.
GriffithBH.The treatment of keloids with triamcinolone acetonide. Plast Reconstr Surg. 1966,
38: 202–8.
5.
JiangYGuoRZhouSWangBSunW.Functional and aesthetic reconstruction of digital flexion contractures with full-thickness plantar skin grafts in children. Dermatol Ther. 2020,
33: e14466.
6.
KimWIKimSChoSWChoMK.The efficacy of bleomycin for treating keloid and hypertrophic scar: a systematic review and meta-analysis. J Cosmet Dermatol. 2020,
19: 3357–66.
7.
KlomparensKSimmanR.Treatment of keloids: a meta-analysis of intralesional triamcinolone, verapamil, and their combination. Plast Reconstr Surg Glob Open. 2022,
10: e4075.
8.
KongBYBaekGHGongHS.Treatment of keloid formation following syndactyly division: surgical technique. Hand Surg. 2012,
17: 433–7.
9.
KoseOWaseemA.Keloids and hypertrophic scars: are they two different sides of the same coin?Dermatol Surg. 2008,
34: 336–46.
10.
LanglaisTRougereauGMarty-DiloyT, et al.
Surgical treatment in child's congenital toe syndactyly: risk factor of recurrence, complication and poor clinical outcomes. Foot Ankle Surg. 2022,
28: 107–13.
11.
LimYJTeohLCLeeEH.Reconstruction of syndactyly and polysyndactyly of the toes with a dorsal pentagonal island flap: a technique that allows primary skin closure without the use of skin grafting. J Foot Ankle Surg. 2007,
46: 86–92.
12.
LiuXGZhangD.Evaluation of efficacy of corticosteroid and corticosteroid combined with botulinum toxin type A in the treatment of keloid and hypertrophic scars: a meta-analysis. Aesthetic Plast Surg. 2021,
45: 3037–44.
13.
MuzaffarARRafolsFMassonJEzakiMCarterPR.Keloid formation after syndactyly reconstruction: associated conditions, prevalence, and preliminary report of a treatment method. J Hand Surg Am. 2004,
29: 201–8.
14.
NiFMaoHYangXZhouSJiangYWangB.The use of an hourglass dorsal advancement flap without skin graft for congenital syndactyly. J Hand Surg Am. 2015,
40: 1748–54.
15.
ParkJHChunJYLeeJH.Laser-assisted topical corticosteroid delivery for the treatment of keloids. Lasers Med Sci. 2017,
32: 601–8.
16.
RenYZhouXWeiZLinWFanBFengS.Efficacy and safety of triamcinolone acetonide alone and in combination with 5-fluorouracil for treating hypertrophic scars and keloids: a systematic review and meta-analysis. Int Wound J. 2017,
14: 480–7.
17.
SunPLuXZhangHHuZ.The efficacy of drug injection in the treatment of pathological scar: a network meta-analysis. Aesthetic Plast Surg. 2021,
45: 791–805.
18.
TanCWXTanWDSrivastavaRYowAPWongDWKTeyHL.Dissolving triamcinolone-embedded microneedles for the treatment of keloids: a single-blinded intra-individual controlled clinical trial. Dermatol Ther (Heidelb). 2019,
9: 601–11.
19.
TianXXiaoJLiTChenWLinQChimH.Single-stage separation of 3- and 4-finger incomplete simple syndactyly with contiguous gull wing flaps: a technique to minimize or avoid skin grafting. J Hand Surg Am. 2017,
42: 257–64.
20.
TolertonSKTonkinMA.Keloid formation after syndactyly release in patients with associated macrodactyly: management with methotrexate therapy. J Hand Surg Eur. 2011,
36: 490–7.
21.
TonkinMAWillisKRLawsonRD.Keloid formation resulting in acquired syndactyly of an initially normal web space following syndactyly release of an adjacent web space. J Hand Surg Eur . 2008,
33: 29–31.
22.
WangBTianXHuY.Treatment of common congenital hand conditions. Clin Plast Surg. 2019,
46: 489–503.
23.
WiderbergARosbergHE.Keloid formation after syndactyly release in a patient with macrodactyly - methotrexate treatment. J Hand Surg Eur. 2019,
44: 216–8.
24.
YamawakiSNaitohMIshikoTAyaRKatayamaYSuzukiS.A toe keloid after syndactyly release treated with surgical excision and intralesional steroid injection. Plast Reconstr Surg Glob Open. 2014,
2: e186.
