Comparison of cosmetic ef­fects after short longitudinal and transverse skin incision for carotid endarterectomy


Authors: T. Hrbáč 1;  D. Školoudík 2;  D. Otáhal 1;  T. Fadrná 1;  R. Herzig 3
Authors‘ workplace: Neurochirurgická klinika FN Ostrava 1;  Centrum vědy a výzkumu, Fakulta zdravotnických věd, Univerzita Palackého v Olomouci 2;  Neurologická klinika, Komplexní cerebrovaskulární centrum, LF UK a FN Hradec Králové 3
Published in: Cesk Slov Neurol N 2019; 82(2): 194-202
Category: Original Paper
doi: 10.14735/amcsnn2019194

Overview

Aim: Nerve injuries, wound complications and poor cosmetic results still have an important impact on the patient’s outcome after carotid endarterectomy (CEA). The study aimed to compare 30-day morbidity and cosmetic outcome between patients undergo­­ing CEA us­­ing short longitudinal incision (SLI) and transverse skin incision (TSI).

Patients and methods: All consecutive patients with internal carotid artery stenosis > 70% indicated for CEA were included in this monocenter prospective study and randomly al­located to the SLI or TSI group. Physical and neurological examinations were performed 30 and 90 days after surgery in all patients. Cosmetic results were evaluated us­­ing the Patient and Observer Scar As­ses­sment Scale (POSAS) 90 days after surgery.

Results: Out of 189 enrol­led patients, SLI was used in 102 (71 males; mean age 64.0 ± 7.1 years) and TSI in 87 patients (58 males; mean age 66.4 ± 7.2 years). Stroke or transient ischemic attack occur­red dur­­ing 30 days in 4 (3.9%) patients in the SLI group and in 2 (2.3%) patients in the TSI group (P = 0.689). The scar quality as­ses­sed us­­ing POSAS was higher in TSI than in SLI patients (12.4 vs. 16.6 points; P < 0.01). Patients in the TSI group did better than SLI patients with regards to scar pigmentation, thicknes­s, relief, pliability and surface area (P < 0.01 in all cases). No significant dif­ferences were found in the occur­rence of local complications (8.0% in TSI and 8.8% in the SLI group; P = 1.00).

Conclusion: Better cosmetic results were observed in patients after CEA us­­ing TSI than SLI. No dif­ferences in 30-day morbidity and in the occur­rence of local complications were observed between the groups.

The authors declare they have no potential conflicts of interest concerning drugs, products, or services used in the study.

The Editorial Board declares that the manu­script met the ICMJE “uniform requirements” for biomedical papers.


颈动脉内膜短纵、横皮肤切口美容效果的比较

目的:

神经损伤、创伤并发症和不良的美容效果对颈动脉内膜切除术(CEA)后患者的预后仍有重要影响。本研究旨在比较短纵切口(SLI)和横切皮肤切口(TSI) CEA术后30天的发病率和美容效果。

患者和方法:

所有连续的颈内动脉狭窄患者均纳入本单中心前瞻性研究,并随机分为SLI组和TSI组。所有患者术后30天和90天均行体格和神经系统检查。术后90天采用患者和观察者疤痕评定量表(POSAS)评定美容效果。

结果:

189名登记患者中,102名(71名男性;平均年龄(64.0±7.1岁)及TSI 87例(男性58例;平均年龄66.4±7.2岁)。SLI组4例(3.9%)、TSI组2例(2.3%)在30天内发生脑卒中或短暂性缺血发作(P = 0.689)。采用POSAS评估的TSI患者瘢痕质量高于SLI患者(12.4分vs. 16.6分;P < 0.01)。TSI组患者瘢痕色素沉着、厚度、缓解程度、柔韧性、表面积均优于SLI组(P < 0.01)。局部并发症发生率无显著性差异(TSI组8.0%,SLI组8.8%;P = 1.00)。

结论:

CEA术后TSI患者的美容效果优于SLI患者。两组间30天的发病率和局部并发症发生率无差异。

关键词:

颈动脉内膜切除术。外科手术切口。美容手术。发病率。问卷调查

Keywords:

carotid endarterectomy – surgical incision – cosmetic surgery – morbidity – questionnaire


Sources

1. Naylor AR, Ricco JB, de Borst GJ et al. Management of atherosclerotic carotid and vertebral artery dis­ease: 2017 clinical practice guidelines of the European Society for Vascular Surgery (ESVS). Eur J Vasc Endovasc Surg 2018; 55(1); 3– 81. doi: 10.1016/ j.ejvs.2017.06.021. 
2. Barnett HJ, Taylor DW, Eliasziw M et al. Benefit of carotid endarterectomy in patients with symp­tomatic moderate or severe stenosis. North american symp­tomatic carotid endarterectomy trial col­laborators. N Engl J Med 1998; 339(20): 1415– 1425. doi: 10.1056/ NEJM199811123392002.
3. Kang JL, Chung TK, Lancaster RT et al. Outcomes after carotid endarterectomy: is there a high-risk population? A national surgical quality improvement program report. J Vasc Surg 2009; 49(2): 331– 338. doi: 10.1016/ j.jvs.2008.09.018.
4. Lokuge K, de Waard DD, Hal­liday A et al. Meta-analysis of the procedural risks of carotid endarterectomy and carotid artery stent­­ing over time. Br J Surg 2018; 105(1): 26– 36. doi: 10.1002/ bjs.10717. 
5. Rerkasem K, Rothwell PM. Carotid endarterectomy for symp­tomatic carotid stenosis. Cochrane Database Syst Rev 2011; 4. doi: 10.1002/ 14651858.CD001081.pub2.
6. Chabowski M, Grzebien A, Ziomek A et al. Quality of life after carotid endarterectomy: a review of the literature. Acta Neurol Belg 2017; 117(4): 829– 835. doi: 10.1007/ s13760-017-0811-x. 
7. Deck M, Kopriva D. Patient and observer scar as­ses­sment scores favour the late appearance of a transverse cervical incision over a vertical incision in patients undergo­­ing carotid endarterectomy for stroke risk reduction. Can J Surg 2015; 58(4): 245– 249.
8. Andrási TB, Kindler C, Dorner E et al. Transverse small skin incision for carotid endarterectomy. Ann Vasc Surg 2015; 29(3): 447– 456. doi: 10.1016/ j.avsg.2014.10.014. 
9. Skil­lman JJ, Kent KC, An­ninos E. Do neck incisions influence nerve deficits after carotid endarterectomy? Arch Surg 1994; 129(7): 748– 752. 
10. As­sadian A, Senekowitsch C, Pfaf­felmeyer N et al. Incidence of cranial nerve injuries after carotid eversion endarterectomy with a transverse skin incision under regional anaesthesia. Eur J Vasc Endovasc Surg 2004; 28(4): 421– 424. doi: 10.1016/ j.ejvs.2004.06.019.
11. Marcucci G, Antonel­li R, Gabriel­li R et al. Short longitudinal versus transverse skin incision for carotid endarterectomy: impact on cranial and cervical nerve injuries and esthetic outcome. J Cardiovasc Surg 2011; 52(2): 145– 152.
12. von Reutern GM, Goertler MW, Bornstein NM et al. Grad­­ing carotid stenosis us­­ing ultrasonic methods. Stroke 2012; 43(3): 916– 921. doi: 10.1161/ STROKEAHA.111.636084.
13. Brott TG, Halperin JL, Abbara S et al. 2011 ASA/ ACCF/ AHA/ AANN/ AANS/ ACR/ ASNR/ CNS/ SAIP/  SCAI/ SIR/ SNIS/ SVM/ SVS guideline on the management of patients with extracranial carotid and vertebral artery dis­ease: executive sum­mary. Vasc Med 2011; 16(1): 35– 77. doi: 10.1177/ 1358863X11399328.
14. Škoda O, Herzig R, Mikulík R et al. Klinický standard pro dia­gnostiku a léčbu pa­cientů s ischemickou cévní mozkovou příhodou a s tranzitorní ischemickou atakou –  verze 2016. Cesk Slov Neurol N 2016; 79/ 112(3): 351– 363. doi: 10.14735/ amcsn­n2016351
15. Draaijers LJ, Tempelman FR, Botman YA et al. The Patient and Observer Scar As­ses­sment Scale: a reliable and feasible tool for scar evaluation. Plast Reconstr Surg 2004; 113(7): 1960– 1965.
16. Stavrou D, Halk J, Weis­sman O et al. Patient and observer scar as­ses­sment scale: how good is it? J Wound Care 2009; 18(4): 171– 176. doi: 10.12968/ jowc.2009.18.4.41610.
17. North American Symp­tomatic Carotid Endarterectomy Trial Col­laborators. Beneficial ef­fect of carotid endarterectomy in symp­tomatic patients with high--grade stenosis. N Engl J Med 1991; 325(7): 445– 453. doi: 10.1056/ NEJM199108153250701.
18. European Carotid Surgery Trialists’ Col­laborative Group. MRC European Carotid Surgery Trial: interim results for symp­tomatic patients with severe (70– 99%) or with mild (0– 29%) carotid stenosis. Lancet 1991; 337(8752): 1235– 1243. 
19. European Carotid Surgery Trialists’ Col­labora­tive Group. Endarterectomy for the moderate symp­tomatic carotid stenosis: interim results from the MRC European Carotid Surgery Trial. Lancet 1996; 347(9015): 1591– 1593. 
20. European Carotid Surgery Trialists’ Group. Randomised trial of endarterectomy for recently symp­tomatic carotid stenosis: final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351(9113): 1379– 1387. 
21. Rothwell PM, Slattery J, Warlow CP. A systematic review of the risks of stroke and death due to endarterectomy for symp­tomatic carotid stenosis. Stroke 1996; 27(2): 260– 265

Labels
Paediatric neurology Neurosurgery Neurology

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Czech and Slovak Neurology and Neurosurgery

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