Abstract Keloid management continues to pose clinical problems. This is because the lesion has a high rate of recurrence after almost any type of treatment. To im- prove results, a triple therapy comprising the use of ste- roid injections and cream (triamcinolone acetonide), sur- gery and silicone gel strip/sheet pressure application was instituted. The results of 120 patients treated within that period of January 1994 to December 1997 at the Komfo Anokye Teaching Hospital (KATH) were analyzed. The follow-up time ranged from 2 to 4 years. The recurrence rate was 12.5% after 13 months with no increase over time. Key words Keloids · Triple therapy · Steroids · Surgery · Silicone application Introduction Normally, wound healing proceeds uneventfully but oc- casionally wounds heal with excessive deposition of col- lagen resulting in keloid formation. Ideally, treatment to reduce collagen formation should interrupt this process. Keloid formation in some individuals can be very disfig- uring. Patients are treated by a variety of methods, none of which is universally reliable [1–5]. Materials and methods One hundred and twenty patients treated for keloids between 1994 and 1997 were evaluated. Of this number, 60% (72) were female, and 40% (48) male. The age range was 5–60 years. In 70% of patients, the keloid was in the head and neck region and in the rest, on the chest wall and trunk, including the breast, sternum, suprapubic area and perineum. Initially, there were 180 patients but 60 discontinued follow-up before the final assessment at 13 months. The treatment protocol is outlined in Table 1. The intrakeloidal (IK) steroid injections were given using a dermo-jet. Results All areas grafted healed primarily. Initial assessment was done at 7 months. At this time, 50% of the patients showed no sign of recurrence. The remaining 60 patients P. Agbenorku ( ✉ ) University P.O. Box 448, Ust, Kumasi, Ghana Fax: +233-51-60137 P. Agbenorku Reconstructive Plastic Surgery and Burns Unit, Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana Eur J Plast Surg (2000) 23:150–151 © Springer-Verlag 2000 ORIGINAL P. Agbenorku Triple keloid therapy: a combination of steroids, surgery and silicone gel strip/sheet for keloid treatment Received: 10 August 1999 / Accepted: 4 December 1999 Table 1 Treatment protocol for triple keloid therapy (TKT) (IK intrakeloidal, TA triamcinolone acetonide, WE wound edges, STSG split-thickness skin graft). If the result is „poor“, repeat stages V and VI systematically. Second assessment on day 300 (10 months) and third assessment on day 390 (13 months) Day 0 IK injection of TA 40–80 mg (Stage I) Day 30 IK injection of TA 40–80 mg (stage II) Day 60 IK injection of TA 40–80 mg (stage III) Day 90 Surgery • Total keloid removal • STSG • TA injection of wound edges (WE) 40 mg (stage IV) Day 104 • WE injection of TA 40 mg • WE massage with TA cream • Silicone gel strip/sheet pressure application (stage V) Day 106 Massage with TA cream. Reapply silicone gel strip/ sheet (Stage VI) Day 108 Repeat Stage VI and on days 110,112,114....132 Day 108 Repeat Stage VI and on days 110,112,114....132 Day 134 Repeat Stage V Day 136 Repeat Stage VI and on days 138,142,144....162 Day 164 Repeat Stage V Day 166 Repeat Stage VI and on days 168,170,172....192 Day 194 Repeat Stage V Day 196 Repeat Stage VI and on days 198,200,202....208 Day 210 Assessment of results: Good=no recurrence Poor=recurrence