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Subject: Earlobe Keloid Excision
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A 1-cc Luer-Lok (twist-on) syringe with 27- or 30-gauge needle
An alcohol swab
Gauze, 4 × 4 inches
Painful or unsightly earlobe keloids
Severe bleeding disorders
Extreme illness that would make wound healing difficult
Cellulitis in the tissues to be incised
Conditions that may interfere with wound healing (collagen vascular diseases, smoking, diabetes)
Concurrent medications that may increase the likelihood of intraoperative bleeding (aspirin, other nonsteroidal anti-inflammatory drugs, warfarin)
Pearl: Prep a wide area so that an undraped area is not inadvertently exposed if the drape slides a little.
Pearl: If the keloid is only in the posterior side, the pinna may be taped over to facilitate removal.
Pearl: Placing a cotton ball in the external ear canal will prevent blood from draining into the canal.
Pearl: Bleeding is common during earlobe keloid excisions. Although closure and pressure clamping will stop most of the minor bleeding, active bleeders need to be addressed by direct pressure or short-term clamping with hemostats.
PITFALL: Absorbable sutures should be avoided, because nonabsorbable sutures such as 5-0 nylon may cause less tissue reaction.
Pearl: Leakage of the steroid from the wound can be reduced by applying tape over the incision site.
Systemic absorption of steroid, with potential worsening of control for diabetic patients
Burning sensation for up to 3 to 5 minutes after injection
Local skin atrophy
Hypopigmentation (temporary or permanent)
Sterile abscess formation
Reformation of keloid