Scar Revision Surgery: The Patient's Perspective

Background Insufficient satisfaction outcome literature exists to assist consultations for scar revision surgery; such outcomes should reflect the patient's perspective. The aim of this study was to prospectively investigate scar revision patient satisfaction outcomes, according to specified patient-selection criteria.

Methods Patients (250) were randomly selected for telephone contacting regarding scar revisions undertaken between 2007-2011. Visual analogue scores were obtained for scars pre- and post-revision surgery. Surgery selection criteria were; 'presence' of sufficient time for scar maturation prior to revision, technical issues during or wound complications from the initial procedure that contributed to poor scarring, and 'absence' of site-specific or patient factors that negatively influence outcomes. Patient demographics, scar pathogenesis (elective vs. trauma), underlying issue (functional/symptomatic vs. cosmetic) and revision surgery details were also collected with the added use of a real-time, hospital database.

Results Telephone contacting was achieved for 211 patients (214 scar revisions). Satisfaction outcomes were '2% worse, 16% no change, and 82% better'; a distribution maintained between body sites and despite whether surgery was functional/symptomatic vs. cosmetic. Better outcomes were reported by patients who sustained traumatic scars vs. those who sustained scars by elective procedures (91.80% vs. 77.78%, P=0.016) and by females vs. males (85.52% vs. 75.36%, P<0.05), particularly in the elective group where males (36.17%) were more likely to report no change or worse outcomes versus females (16.04%) (P<0.01).

Conclusions Successful scar revision outcomes may be achieved using careful patient selection. This study provides useful information for referring general practitioners, and patient-surgeon consultations, when planning scar revision.

Keywords

Patient satisfaction - Scarring - Standards - Plastic surgery - Patient selection

Publication History

Received: 21 April 2015

Accepted: 06 July 2015

Article published online:
05 May 2022

• References

• 1 Parkhouse N, Cubison TC, Humzah MD. Scar revision. In: Mathes SJ, Hentz VR. Plastic surgery. 2nd ed. Philadelphia: Saunders; 2006: 235-268
• 2 Perez-Bustillo A, Gonzalez-Sixto B, Rodriguez-Prieto MA. Surgical principles for achieving a functional and cosmetically acceptable scar. Actas Dermosifiliogr 2013; 104: 17-28
• 3 van Zuijlen PP, Angeles AP, Kreis RW. et al. Scar assessment tools: implications for current research. Plast Reconstr Surg 2002; 109: 1108-1122
• 4 Mallucci P, Abood A, Bistoni G. The dermal tube: a versatile tool in scar revision. J Plast Reconstr Aesthet Surg 2009; 62: 1223-1226
• 5 Cavadas PC. The three-dimensional Z-plasty for the treatment of depressed adhered scars. Plast Reconstr Surg 2001; 107: 1076-1077
• 6 Klein AW. Skin filling. Collagen and other injectables of the skin. Dermatol Clin 2001; 19: 491-508
• 7 Fagien S, Elson ML. Facial soft-tissue augmentation with allogeneic human tissue collagen matrix (Demalogen and Dermaplant). Clin Plast Surg 2001; 28: 63-81
• 8 McGregor AD, McGregor IA. Fundamental techniques of plastic surgery and their surgical applications. 10th ed London: Churchill Livingston; 2000
• 9 Billings Jr E, May Jr JW. Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 1989; 83: 368-381
• 10 Batra RS. Surgical techniques for scar revision. Skin Therapy Lett 2005; 10: 4-7
• 11 Sullivan T, Smith J, Kermode J. et al. Rating the burn scar. J Burn Care Rehabil 1990; 11: 256-260
• 12 Beausang E, Floyd H, Dunn KW. et al. A new quantitative scale for clinical scar assessment. Plast Reconstr Surg 1998; 102: 1954-1961
• 13 Martin D, Umraw N, Gomez M. et al. Changes in subjective vs objective burn scar assessment over time: does the patient agree with what we think. J Burn Care Rehabil 2003; 24: 239-244
• 14 Schweinfurth JM, Fedok F. Avoiding pitfalls and unfavourable outcomes in scar revision. Facial Plast Surg 2001; 17: 273-278
• 15 Broughton 2nd G, Crosby MA, Coleman J. et al. Use of herbal supplements and vitamins in plastic surgery: a practical review. Plast Reconstr Surg 2007; 119: 48e-66e
• 16 Watson D, Reuther MS. Scar revision techniques-pearls and pitfalls. Facial Plast Surg 2012; 28: 487-491
• 17 Krueger JK, Rohrich RJ. Clearing the smoke: the scientific rationale for tobacco abstention with plastic surgery. Plast Reconstr Surg 2001; 108: 1063-1073
• 18 di Summa PG, Wettstein R, Erba P. et al. Scar asymmetry after abdominoplasty: the unexpected role of seroma. Ann Plast Surg 2013; 71: 461-463
• 19 Yang JY, Yang SY. Are auricular keloids and persistent hypertrophic scars resectable? The role of intrascar excision. Ann Plast Surg 2012; 69: 637-642
• 20 Linn L, Goldman IB. Psychiatric observations concerning rhinoplasty. Psychosom Med 1949; 11: 307-314
• 21 Gifford S. Cosmetic surgery and personality change: a review and some clinical observations. In: Goldwyn RM, Mimis C. The unfavorable result in plastic surgery: avoidance and treatment. Boston: Little Brown; 1972: 11-33
• 22 Picavet VA, Gabriels L, Grietens J. et al. Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty. Plast Reconstr Surg 2013; 131: 861-868
• 23 Constantian MB. The new criteria for body dysmorphic disorder: who makes the diagnosis?. Plast Reconstr Surg 2013; 132: 1759-1762
• 24 Barone M, Cogliandro A, Persichetti P. Preoperative symptoms of body dysmorphic disorder determine postoperative satisfaction and quality of life in aesthetic rhinoplasty. Plast Reconstr Surg 2013; 132: 1078e-1079e