A Toe Keloid after Syndactyly Release Treated with Surgical Excision and Intralesional Steroid Injection

Abstract

Summary:A keloid is a benign fibroproliferative disease of unknown etiology. Although it is common among Asians, the development of keloid on the foot is rare. We experienced a case of a keloid which arose on the foot of a 4-year-old boy after the surgical release of syndactyly. He had congenital cutaneous syndactyly of the third and fourth toes. After the reconstructive operation was performed when the patient was 2 years old, the wound became hypertrophic and grew to 37 × 37 × 8 mm. After the diagnosis of keloid based on a pathological examination, the keloid was resected completely. The web was reconstructed with a planter rectangular flap, and the skin defects were covered with a full-thickness skin graft. After the operation, we administered 5 intralesional steroid injections. Finally, the keloid was diminished 2 years after the operation.

Toe Keloids Treated with Core Excision, Postoperative Radiotherapy, and Steroid Plaster

“…The surgery often involved total excision followed by skin grafting. 1 , 2 , 9 None employed core excision. In core excision, only the fibrous mass of the keloid is removed; the tissues on top are partly spared and serve as flaps to close the defect after excision.…”

“…In most of the previous case reports on toe keloids, surgery was combined with postoperative compression therapy, 4 steroid injections, 2 , 5 , 7 or methotrexate treatment. 9 However, in a recent case, Liu et al 8 reported removing two big-toe keloids from a patient via total excision followed by skin-flap transplantation, after which the toes were irradiated to prevent recurrence and subjected to hyperbaric-oxygen therapy to prevent any blood flow disorders in the flaps.…”

“… 1 , 5 Others required surgery, which often consisted of total excision and full-thickness skin grafting. 1 , 2 , 4 – 9 A good surgical alternative may be the core-excision method, where the fibrous mass of the keloid is removed and the tissue retained over the keloid serves as a flap. This method is highly effective with auricular keloids.…”

Toe keloid after nail extraction treated with surgical excision

“…Keloid formation on the toes and fingers is rare, and thus far, only 22 cases in 9 studies have been reported. [ 7 – 15 ] Keloid formation after nail extraction is also quite rare. No previous report has identified a keloid caused by nail extraction.…”

An Odd Keloid Formation after Treatment of Congenital form of Boutonniere Finger

“…Keloids are rare on digits and only 23 cases have been reported in 10 studies, with most of them appearing following syndactyly treatment. 5 There have been no reports on keloid formation after congenital form of Boutonniere deformity. There is no consistent standard treatment available for keloids formed in the toes and fingers.…”