A Combined Protocol for Toe Keloid Lesions After Pediatric Syndactyly Release
Liu Xurong, Renliang He
BACKGROUND
Toe Keloid Disorder developing after syndactyly release is infrequently described but can be highly disruptive for pediatric patients due to symptoms, cosmetic burden,
and functional impairment related to interdigital tethering or progressive re adhesion.
Evidence guiding toe-specific management in children is limited, and many single- modality approaches provide incomplete control in anatomically constrained webspaces.
We evaluated a multimodal protocol integrating punch excision, fractional CO2 laser therapy, and intralesional pingyangmycin designed to (1) mechanically debulk and decompress thick toe Keloid Lesions, (2) remodel lesion architecture while releasing interdigital adhesion to improve mobility, and (3) locally suppress fibroproliferative activity. This study evaluated a multimodal protocol combining punch excision, fractional ablative remodeling (CO2 laser), and targeted intralesional chemotherapy (pingyangmycin), assessing its association with measurable improvement in clinical severity scores and an acceptable short-term safety profile.
CONCLUSION
In this retrospective pediatric cohort with toe Keloid Disorder after syndactyly release, a combined protocol of punch excision, fractional CO2 laser therapy, and
intralesional pingyangmycin was associated with improvement in overall clinical severity and multiple VSS domains, with an acceptable short-term safety
profile. This multimodal approach may be particularly useful for toe Keloid Lesions in anatomically constrained webspaces where debulking and mobility restoration are
clinical priorities. Key limitations include small sample size, retrospective design, and absence of long-term recurrence endpoints. Prospective studies with larger
cohorts, standardized functional measures (e.g., toe range of motion, webspace depth), and extended follow-up are warranted to evaluate durability, optimize dosing intervals, and compare this protocol with other multimodal strategies.
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