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Outcomes of Cutaneous Scar Revision During Surgical Implant Removal in Children with Cerebral Palsy

Davids, Jon R. MD; Diaz, Kevin MD; Leba, Thu-Ba MD; Adams, Samuel MD; Westberry, David E. MD; Bagley, Anita M. PhD, MPH

Journal of Bone & Joint Surgery - American Volume: 17 August 2016 - Volume 98 - Issue 16 - p 1351–1358
doi: 10.2106/JBJS.15.01418
Scientific Articles

Background: Children who have had surgery involving the placement of an implant frequently undergo a subsequent surgery for hardware removal. The cosmesis of surgical scars following initial and subsequent surgeries is unpredictable. Scar incision (subsequent surgical incision through the initial scar) or excision (around the initial scar) is selected on the basis of the quality of the initial scar. The outcomes following these techniques have not been determined.

Methods: This prospective, consecutive case series was designed to compare outcomes following surgical scar incision versus excision at the time of implant removal in children with cerebral palsy. Photographs of the scars were made preoperatively and at 6 and 12 months following implant removal and were graded for scar quality utilizing the modified Stony Brook Scar Evaluation Scale (SBSES). Parental assessment of scar appearance was performed at the same time points utilizing a visual analog cosmetic scale (VACS).

Results: The scars that were selected for incision had significantly worse SBSES scores at 6 and 12 months following the second surgery compared with preoperative values. However, parents’ VACS scores of the incised scars, although worse at 6 months, were comparable with preoperative scores at 12 months. Scars that were selected for excision had significantly worse SBSES scores at 6 months but scores that were comparable with preoperative values at 12 months. VACS scores for the excised scars were comparable at the 3 time points.

Conclusions: Surgical incisions that initially healed with good scar quality generally healed well (from the parents’ perspective) following subsequent incision through the previous scar. Surgical incisions that initially healed with poor scar quality did not heal better following excision of the previous scar. In such situations, surgical excision of the existing scar should occur in conjunction with additional adjuvant therapies to improve cosmesis.

Level of Evidence: Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.

1Shriners Hospitals for Children-Northern California, Sacramento, California

2Shriners Hospitals for Children-Greenville, Greenville, South Carolina

E-mail address for J.R. Davids: jdavids@shrinenet.org

Copyright 2016 by The Journal of Bone and Joint Surgery, Incorporated
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