From the Research
The most effective treatment for keloid formation at the sternotomy site following Coronary Artery Bypass Grafting (CABG) is a multimodal approach, with first-line therapy including silicone gel sheets or silicone-based creams, in combination with intralesional corticosteroid injections, as supported by the most recent and highest quality study 1.
Treatment Approach
The treatment of keloid scars involves a combination of therapies to reduce the size and symptoms of the scar. The following are some of the treatment options:
- Silicone gel sheets or silicone-based creams: These should be applied daily for at least 12 hours per day for 2-3 months to help hydrate the scar and reduce collagen production.
- Intralesional corticosteroid injections: Specifically, triamcinolone acetonide (10-40 mg/ml) administered every 4-6 weeks for several months to suppress inflammation and inhibit fibroblast proliferation.
- Pressure therapy: Using custom-made garments that apply 24-30 mmHg of pressure for at least 23 hours daily for 6-12 months to induce hypoxia in the keloid tissue.
Additional Therapies
For resistant cases, consider more aggressive interventions such as:
- Cryotherapy
- Laser therapy (pulsed dye or CO2 lasers)
- Surgical excision followed by immediate adjuvant therapy to prevent recurrence
- Radiation therapy (15-20 Gy in fractionated doses) within 24-48 hours after surgical excision to significantly reduce recurrence rates.
Importance of Early Treatment
It's essential to note that keloids have high recurrence rates, so combination therapy is often necessary, and treatment should begin early for optimal results. Patients should be counseled about the chronic nature of keloid management and the need for consistent, long-term treatment, as highlighted in the study 1.
Key Considerations
When treating keloid scars, it's crucial to consider the individual patient's needs and the severity of the scar. The treatment approach should be tailored to the patient's specific condition, and a combination of therapies may be necessary to achieve optimal results, as supported by the study 2.