Surgical Excision and Intralesional Steroid Injection for Prevention of Post Caesarean Keloid Recurrence
Keloid
About this trial
This is an interventional prevention trial for Keloid focused on measuring recurrent keloid, surgical excision, steroids injection
Eligibility Criteria
Inclusion Criteria:
- Documented keloids of pfannenstiel incision or midline subumbilical incision of one to five years duration.
- Previous treatment of keloid and recurrence.
- Patient complaint of cosmetic disfiguring, pain or pruritis at site of scar.
Exclusion criteria:
- Scar <1 years' duration
- Scar extending beyond the limits of the original lesion
- postburn keloids
- Diabetes Mellitus, anaemia (haemoglobin level <10mg/dL), malignancy, malnutrition.
- local inflammation at site of scar
- Allergy to dexamethasone.
- Immunocompromized patients or patients on chronic steroid treatment.
Sites / Locations
- KasralainiH
Arms of the Study
Arm 1
Arm 2
Active Comparator
Active Comparator
excision only group
excision and injection group
Under general or spinal anaesthesia done routinely during caesarean section, total extralesional surgical excision of keloid is performed and minimal undermining followed by usual steps of caesarean section. Primary closure of wound in layers is achieved in all cases. A running subcuticular prolene 2/0 stitch is used to suture the skin. Group A of 73 patients will not receive further injection. The wound is painted with betadine and sealed until postoperative day 14, at which time the subcuticular stitch is removed. Routine postoperative medications are given to all patients. They are advised to avoid direct sun exposure for the following month. No postoperative applications (eg, compression, steroid injections, etc) are used in any of the patients. All patients are reviewed once per month for 6 months.
Under general or spinal anaesthesia done routinely during caesarean section, total extralesional surgical excision of keloid is performed and minimal undermining followed by usual steps of caesarean section and primary closure of the wound in layers. A running subcuticular prolene 2/0 stitch is used to suture skin.In 73 patients (group B), wound edges are injected once with dexamethasone. A 1 mL syringe with a 30-gauge needle is used both intradermal and subdermal. Repeated alternate punctures are used to bathe the wound edges with the drug. Approximately 0.5-1 mL of dexamethasone (4 mg/mL) in wound tissue. The wound is painted with betadine and sealed until postoperative day 14 to remove the subcuticular stitch. Routine postoperative medications are given, avoidance of direct sun exposure for one month,No postoperative applications as compression, steroid injections, etc. All patients are reviewed once per month for 6 months.