Scar Revision Surgery: The Patient's Perspective

Abstract

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; Patient selection; Plastic surgery; Scarring; Standards.

Fig. 1. Proportion (%) and numbers of scar revision procedures (n=214) undertaken by body site

The proportion of procedures performed by body site were; head and neck (34.1%, n=73), chest and axilla (23.8%, n=51), abdomen (17.8%, n=38), pelvis and perineum (1.4%, n=3), back (2.3%, n=2), upper limb (11.2%, n=24), lower limb and gluteal region (9.3%, n=20).

Fig. 2. Scar revision patient satisfaction outcomes (%) by body site

Overall scar revision patient satisfaction outcomes were as follows; 2.34% (5/214) worse, 15.89% (34/214) no change, 81.78% (175/214) better, distributions that remained similar regardless of body site.

Fig. 3. Scar revision patient satisfaction outcomes for scars pathogenesis (elective vs. trauma), stratified by body site

Patients who sustained scars from trauma (91.80%) were more likely to report better scar revision satisfaction outcomes than those who sustained scars in the elective setting (77.78%) (P=0.016), hence patients who sustained scars in the elective setting (22.22%) were more likely to report no change or worse outcomes than those who sustained scars from trauma (8.20%) (P=0.016). Patients who sustained scars in the elective setting (19.61%) were more likely to report no change in outcome compared to those who sustained scars from trauma (6.56%) (P=0.02). Worse scar revision outcomes were similar for those sustained in the elective setting vs. trauma (2.61% vs. 1.64%, P=0.67). These distributions remained similar regardless of body site. E (blue), patient group with scars sustained from elective surgery; T (red), patient group with scars sustained from trauma; H&N, head & neck; Ax, axilla; Abdo, abdomen; LL/Glut, lower limb/gluteal; UL, upper limb; Pelv/Perin, pelvis/perineum.