Comparison of W-Plasty and Straight-Line Trichophytic Closure on Aesthetic Outcomes of Occipital Hairline Scars in Rhytidectomy

Rhytidectomy Incision Techniques and Scar Outcomes: A Scoping Review

Although scar outcomes in rhytidectomy are crucial to patients and surgeons alike, there is a lack of consensus on incision techniques for optimizing rhytidectomy scars. A comprehensive scoping review of the literature was performed on rhytidectomy incision techniques and associated scar outcomes.The PRISMA protocol was utilized to conduct a scoping review of the literature through MEDLINE, EMBASE, and Science Citation Index databases to identify articles discussing rhytidectomy incision techniques and scar outcomes.A total of 49 studies were included in this scoping review. Four themes were identified related to rhytidectomy scars within these studies: temporal incision placement, tragal incision placement, lobule management, and postauricular incision design. Techniques within each theme were described and reported scar outcomes summarized.There are many approaches to rhytidectomy incisions described in the literature, with reportedly low rates of scar complications for each of the techniques described. It cannot be elucidated which techniques are superior due to the heterogeneity of outcomes reported in the literature with significant variability in outcome measures, study design, and follow-up time. Future studies should focus on utilizing a standardized rating system to aid in objective determination of the superiority of one technique versus another. LEVEL OF EVIDENCE:: Level I.

Comparing Cosmetic Outcomes of Straight-Line Versus W-Plasty Techniques for Linear Postauricular Wound Closure: A Randomized Evaluator Blind Split-Scar Trial

BACKGROUND

Surgeons' opinions vary on the cosmetic outcome of straight-line (SL) versus broken-line (W-plasty) closure methods. To date, no studies have compared the 2 techniques in the split-scar design model that resolves the confounding individual patient factors that affects the scar outcome.

OBJECTIVE

Compare outcomes and wound cosmesis with SL versus W-plasty closure techniques.

METHODS

This clinical trial was conducted with 50 linear surgical wounds randomized to SL closure on half and W-plasty on the other half. At 3 months, patients and 2 masked observers evaluated each scar using the Patient and Observer Scar Assessment Scale (Patient Observer Scar Assessment Scale [POSAS]).

RESULTS

The mean (SD) sum of the POSAS observer component scores were 16.6 (6.18) for the SL side and 15.5 (6.37) for the W-plasty side ( p = .49). The mean (SD) sum of the POSAS patient scores were 14.4 (6.8) in SL and 15.1 (8.2) in W-plasty ( p = .59). The mean (SD) complications were 0.08 (0.06) for SL and 0.02 (0.14) for W-plasty ( p = .18).

CONCLUSION

No statistically significant difference in wound cosmesis or complications was noted between SL versus W-plasty closure techniques. Surgeons may want to consider whether the extra time involved in placing zigzag W-plasty lines is worthwhile.

The Rhytidectomy Scar: Analysis of Patient and Surgeon Perspectives

An understanding of patient preference is vital for surgeons to create outcomes that align with the goals of patients undergoing cosmetic surgery. This study analyzes the perception of the rhytidectomy scar from the perspective of cosmetic patients and surgeons. Cross-sectional surveys were administered in-person to cosmetic patients and online to facial plastic and reconstructive surgeons in the United States. Participants were presented with standardized lateral view photographs of preauricular scars for 10 patients at least 12 months post rhytidectomy procedure. A variety of rhytidectomy incisions were chosen to include pre- versus post-tragal incisions, blunted hair tuft, hypopigmentation, narrow versus wide scar healing. Participants were asked to rate the outcome of the preauricular rhytidectomy scar using the Likert scale from 1 to 10. Quantitative analysis indicates that while both surgeons and cosmetic patients viewed hypopigmented scars less favorably, surgeons were more concerned with pre-tragal incision and blunted hair tuft. Furthermore, the number of rhytidectomies performed by surgeons resulted in more critical analysis of the scars presented in this study. Qualitative analysis of the frequent use of "natural" in the patient comments suggests the importance of maintaining a sense of "normalcy" as well. In contrast, the surgeon comments are most frequently about the relationship between the scar and surrounding anatomical structures, suggesting a descriptive focus on the technicality of scar placement and subsequent anatomical result. Cosmetic patients are primarily concerned about scar appearance while surgeons are more focused on the technical orientation of the scar. An understanding and comparison of the language and perceptions of surgeons and cosmetic patients regarding rhytidectomy scars are vital in creating aesthetic results and managing patient expectations.

Continuous tension reduction technique in facial scar management: A comparison of W-plasty and straight-line closure on aesthetic effects in Asian patients

W-plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W-plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W-plasty with continuous tension-reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12-month follow-up. Clinical results showed a significant difference in scar appearance between different groups at 12-month follow-up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W-plasty and CTR than other groups at 12-month follow-up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W-plasty, this technique could significantly improve the scar's aesthetic appearance.

Unilateral Cleft Lip Repair: A Quantitative Scale Assessment of Postoperative Lip and Nose Scars Across 2 Operative Techniques

BACKGROUND

There is no quantitative evidence supporting one unilateral cleft lip (UCL) repair technique over the other with regard to scarring. We sought to evaluate the difference between the extended Mohler and Millard techniques, using 3 scar assessment scales.

METHODS

Postoperative frontal and basal photographs of patients undergoing UCL repair were reviewed. Three validated scar assessment scales were used: the Manchester Scar Scale (MSS), modified scar-rating scale (MSRS), and Stony Brook Scar Evaluation Scale. Lip and nose scars were rated by 5 independent raters using each of the scales. Interrater reliability was assessed using the intraclass correlation coefficient (ICC).

RESULTS

Assessment of 116 images for 58 consecutive patients undergoing UCL repair (36 extended Mohler, 22 Millard) was performed. Interrater reliability was excellent for lip scars (ICCs, 0.903 [0.857-0.938] for MSS, 0.913 [0.872-0.944] for MSRS, and 0.850 [0.775-0.902] for SBES) and moderate for nose scar assessment (ICCs, 0.714 [0.579-0.816] for MSS, 0.693 [0.548-0.802] for MSRS, and 0.565 [0.359-0.720] for SBES). No statistically significant difference was found between the extended Mohler and Millard repairs in mean lip scar scores (MSS, 6.983 ± 1.469 vs 6.772 ± 1.175, P = 0.571; MSRS, 5.433 ± 1.530 vs 5.481 ± 1.290, P = 0.902; SBES, 3.633 ± 0.977 vs 3.446 ± 0.995, P = 0.483) or nose scar scores (MSS, 5.644 ± 1.131 vs 5.491 ± 0.689, P = 0.523; MSRS, 4.233 ± 0.987 vs 3.991 ± 0.705, P = 0.320; SBES, 3.933 ± 0.750 vs 4.018 ± 0.486, P = 0.603).

CONCLUSIONS

Using 3 validated scar assessment scales, no significant difference was found between the extended Mohler and Millard techniques in terms of lip or nose scars.