Midline Chest - Sternal Post Thoracotomy Keloid
This is a 51-year-old female who four years earlier, at age of 47, underwent coronary bypass surgery. Soon after surgery, keloids started forming at the surgical wound sites. A surgical resection was performed about a year after the initial surgery, yet the problem returned even worse than before.
She received several steroid injections without success. Over time, her keloid became very painful to a point that simply touching of the skin caused her tremendous pain.
She was self-referred to our practice for consultation and exploring other treatment options. In addition to coronary heart disease, she also suffers from hypertension
Dr. Tirgan's Treatment approach to this keloid
This is a challenging case, and very typical of the sternal keloids that almost always relapse after surgery. The main issue for this patient was pain which interferes with her daily life as well as her sleep.
Our first goal is pain control which cannot be achieved without treating the underlying cause. With failure of steroids, the next best option is treatment with chemotherapy. The patient consented to the treatment on Sept 4, 2014, however, her skin was so painful that we were only able to inject the top 1 inch of her keloid on that day. She was practically in tears from pain which was aggravated by the injections. We had to interrupt her treatment on that day.
She returned on September 23, 2014, to continue the treatment. Although only a small portion of the whole lesion was previously injected with chemotherapy, she had achieved almost near-total pain relief in that area. This significant pain relief encouraged her to return for more treatment, which we were able to accomplish on the same day. It is of interest, that the top part of her keloid had clear evidence of regression that was due to partial injection of three weeks earlier.
Another interesting aspect of her case, is the history of hypertension and coronary artery disease, requiring treatment at a relatively early age. This supports the notion that the Disorder is a systemic illness, associated with higher prevalence of coronary artery disease as well as hypertension.
We will post follow up on this case in a few weeks.