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Choi WK, Shin HY, Park YJ, Lee SH, Lee AY, Hong JS. Analysis of trends and status of evaluation methods in thyroid scar. Heliyon 2024; 10:e29301. [PMID: 38720695 PMCID: PMC11076647 DOI: 10.1016/j.heliyon.2024.e29301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2023] [Revised: 03/29/2024] [Accepted: 04/04/2024] [Indexed: 05/12/2024] Open
Abstract
Background The incidence of thyroid cancer has increased over the decades, and patients prefer short thin scars after thyroidectomy due to their cosmetic visibility. Several scar assessment methods have been used to determine the most cosmetically optimal surgical method, but a widely accepted measurement tool is still lacking. This study investigates the usage status in the thyroid scar scale according to time, region, and study method. Methods The authors searched for articles on thyroid scars published between January 2000 and September 2022 in the PubMed database. The study included clinical studies that mentioned thyroid scar and scar scale, excluding articles that did not evaluate neck scars. Statistical analysis was performed using IBM SPSS Statistics 29. Results A total of 35 studies were included. Among them, 17 used the Vancouver Scar Scale (VSS), 17 used the Patient and Observer Scar Assessment Scale (POSAS), four used the Manchester Scar Scale (MSS), and four used the Stony Brook Scar Evaluation Scale (SBSES). VSS and POSAS were the most commonly used scar evaluation methods. VSS tended to be used frequently in Asia, while POSAS was used frequently in Europe and in randomized controlled trials. Conclusion VSS and POSAS are popular thyroid scar assessment methods, with regional variations. Standardization is needed for meaningful comparisons. Patient's subjective evaluations should be considered, given the cosmetic importance of thyroid scars.
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Affiliation(s)
- Woo Kyoung Choi
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Hui Young Shin
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Yu Jeong Park
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Seung Ho Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Ai-Young Lee
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
| | - Jong Soo Hong
- Department of Dermatology, Dongguk University Ilsan Hospital, College of Medicine, Dongguk University, Goyang, South Korea
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Hong N, Sheng B, Yu P. Early postoperative interventions in the prevention and management of thyroidectomy scars. Front Physiol 2024; 15:1341287. [PMID: 38523809 PMCID: PMC10958159 DOI: 10.3389/fphys.2024.1341287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2023] [Accepted: 02/26/2024] [Indexed: 03/26/2024] Open
Abstract
Thyroidectomy scars, located on the exposed site, can cause distress in patients. Owing to the cosmetic importance of thyroidectomy scars, many studies have been conducted on its prevention and treatment. Scar formation factors mainly include inflammatory cell infiltration, angiogenesis, fibroblast proliferation, secretion of cytokines such as transforming growth factor (TGF)-β1, and mechanical tension on the wound edges. Anti-scar methods including topical anti-scar agents, skin tension-bearing devices, and local injections of botulinum toxin, as well as lasers and phototherapies, that target these scar formation factors have been developed. However, current studies remain fragmented, and there is a lack of a comprehensive evaluation of the impacts of these anti-scar methods on treating thyroidectomy scars. Early intervention is a crucial but often neglected key to control hyperplastic thyroidectomy scars. Therefore, we review the currently adopted early postoperative strategies for thyroidectomy scar reduction, aiming to illustrate the mechanism of these anti-scar methods and provide flexible and comprehensive treatment selections for clinical physicians to deal with thyroidectomy scars.
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Affiliation(s)
- Nan Hong
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
- Department of Dermatology, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
| | - Bin Sheng
- Department of Medical Cosmetology, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China
| | - Pan Yu
- Department of Burn and Plastic Surgery, Jinling Hospital, Affiliated Hospital of Medical School, Nanjing University, Nanjing, China
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Restrepo S, Rojas S, Sanabria A. Satisfaction With Head and Neck Scar Appearance in Latin American Patients: A Cross-Sectional Study. EPLASTY 2023; 23:e56. [PMID: 37743968 PMCID: PMC10517663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 09/26/2023]
Abstract
Background Surgical scars have been related to poor quality of life, and this is important for head and neck scars. There is a paucity of data about the effect of scars on appearance in Latin American patients. The objective of this study was to describe the self-assessment of patient scars using the Patient Scar Assessment Questionnaire (PSAQ). Methods This is a cross-sectional study. The validated Spanish version of the PSAQ was used. Adult patients who underwent elective head and neck surgery were included. Demographic and clinical data were obtained from clinical charts. Univariate and multivariate analysis using a forward logistic regression was planned to assess the weight of specific subscale items on the overall subscale score for appearance and satisfaction with appearance. Results 180 patients were recruited. A total of 144 (80%) patients were female, and the most frequent type of surgery was thyroidectomy. The global appearance, the global scar consciousness and the global scar appearance satisfaction was classified as excellent/good in 72.2%, 93.9% and 87.8% of patients, respectively. The multivariate analysis showed that color (OR 5.9, 95% CI 1.7-20.8), width (OR 58.9, [4.3-807.6]), and flatness (OR 5.7, [1.3-23.6]) were the items statistically associated with a regular/bad result in the appearance subscale. Conclusions There is a high level of satisfaction with head and neck scar appearance, and these data should be used to assess the impact of surgical interventions on cosmesis. The intrinsic characteristics of scars are the most relevant for defining scar satisfaction.
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Affiliation(s)
- Santiago Restrepo
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
| | - Santiago Rojas
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
| | - Alvaro Sanabria
- Department of Surgery, Universidad de Antioquia School of Medicine, Medellin, Colombia
- Head and Neck Service, Fundación Colombiana de Cancerología- Clínica Vida, Medellín, Colombia
- Centro de Excelencia en Enfermedades de Cabeza y Cuello, CEXCA, Medellín, Colombia
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Charoenlux P, Utoomprurkporn N, Seresirikachorn K. Cyanoacrylate Tissue Adhesives Compared With Sutures on Facial and Neck Wounds: A Meta-analysis. OTO Open 2023; 7:e73. [PMID: 37693830 PMCID: PMC10487314 DOI: 10.1002/oto2.73] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2023] [Accepted: 08/09/2023] [Indexed: 09/12/2023] Open
Abstract
Objective To compare the effectiveness between cyanoacrylate tissue adhesives (CTAs) and sutures for skin closure on the face and neck. Data Sources Embase, Medline, Scopus, Central, Web of Science. Review Methods Randomized controlled trials comparing CTAs versus sutures for skin closure on the face and neck were included. Primary outcomes were cosmetic outcomes. Secondary outcomes were scar depth, scar width, pain, closure time, cost, and adverse events. Subgroup analyses were performed by wound locations, type of CTAs, type of sutures, age groups, and type of wounds. Physicians and patients evaluated the cosmetic outcomes. Results Eighteen studies (1020 patients) were included. CTAs offered better cosmetic outcomes by Wound Registry Scale at ≤1 month (physician: mean difference [MD]: -1.50, 95% confidence interval, CI: -2.42 to -0.58). The cosmetic outcomes assessed by Visual Analog Scale were comparable at >1 to ≤3 months (physicians: standard mean difference [SMD], -0.01, 95% CI, -0.25 to 0.23, patients: SMD, -0.02, 95% CI, -0.84 to 0.79). The cosmetic outcomes by the Patient and Observer Scar Assessment Scale favored sutures at >3 to 12 months (physician: MD 4.26, 95% CI, 2.02-6.50). Subgroup analyses revealed no differences. CTAs offered less scar depth, scar width, pain, closure time, and total cost of closure. Adverse events were similar. Conclusion Based on the wound healing process, the cosmetic outcomes exhibited a favorable inclination toward CTAs at <1 month while demonstrating comparable results between CTAs and sutures at >1 to ≤3 months. Subsequently, sutures exhibited superior cosmetic outcomes compared to CTAs at >3 to 12 months.
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Affiliation(s)
- Prapitphan Charoenlux
- Department of OtolaryngologyFaculty of Medicine, Chulalongkorn UniversityBangkokThailand
| | - Nattawan Utoomprurkporn
- Department of OtolaryngologyFaculty of Medicine, Chulalongkorn UniversityBangkokThailand
- Faculty of Brain Science, UCL Ear InstituteUniversity College LondonLondonUK
| | - Kachorn Seresirikachorn
- Department of OtolaryngologyFaculty of Medicine, Chulalongkorn UniversityBangkokThailand
- Endoscopic Nasal and Sinus Surgery Excellence CenterKing Chulalongkorn Memorial HospitalBangkokThailand
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Musham A, Samuel EM, Sahoo AK, Elamurugan T, Manwar A. Comparison of Tissue Adhesive Glue with Subcuticular Absorbable Suture for Skin Closure Following Thyroid Surgery: A single-blinded randomised controlled trial. Sultan Qaboos Univ Med J 2023; 23:42-47. [PMID: 36865424 PMCID: PMC9974034 DOI: 10.18295/squmj.1.2022.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 11/02/2021] [Accepted: 11/25/2021] [Indexed: 11/16/2022] Open
Abstract
Objectives This study aimed to compare the skin closure time, postoperative pain and the scar outcome between tissue adhesive and sub-cuticular sutures in thyroid surgery. Methods This study was conducted in Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Puducherry, a tertiary care hospital in India from March 2017 to December 2019. Adult patients undergoing thyroid surgery were included while those with previous neck surgery, history of keloids/hypertrophic scars and those undergoing concomitant neck dissections were excluded. Following platysma closure, patients were randomised into two groups (tissue adhesive and subcuticular sutures) using the Serially Numbered Opaque Sealed Envelopes technique. A sample size of 64 in each group was calculated for this prospective, single-blinded and randomised controlled trial. The primary outcome was the skin closure time. The secondary outcomes were postoperative pain at 24 hours and scar scoring at 1st and 3rd postoperative month. Statistical analysis was done using SPSS software. Results A total sample of 124 patients were included in this study, with 61 patients assigned to the suture group and 63 assigned to the tissue adhesive group. The median skin closure time and postoperative pain was significantly lower in the tissue adhesive group as compared to the suture group (P <0.01). There was no statistically significant difference in scar outcome at the 1st or 3rd months between both groups (P = 0.088 and 0.137, respectively). There were no wound-related complications in either group. When a subgroup analysis was conducted, no difference was seen in the scar outcome or wound-related complications in patients with comorbidities. There were no instances of allergic contact dermatitis to the tissue adhesive. Conclusion The use of tissue adhesive leads to lower operative time and less postoperative pain in thyroid surgeries. The scar outcome is comparable between tissue adhesives and subcuticular sutures.
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Affiliation(s)
- Aditya Musham
- Department of Paediatric Surgery, Lady Hardinge Medical College, New Delhi, India
| | - Evangeline M.K. Samuel
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - Ashok K. Sahoo
- Department of Surgery, S.C.B Medical College and Hospital, Cuttack, India,Corresponding Author’s e-mail:
| | - T.P. Elamurugan
- Department of Surgery, Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry, India
| | - A.S. Manwar
- Department of Surgery, All India Institute of Medical Sciences, Bhuvaneshwar, India
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Qiu Q, Qiu Y, Lu G. Letter to the editor on "A cosmetic tour of thyroid surgery". Asian J Surg 2023:S1015-9584(23)00026-X. [PMID: 36631379 DOI: 10.1016/j.asjsur.2022.12.137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 12/29/2022] [Indexed: 01/11/2023] Open
Affiliation(s)
- Qianhui Qiu
- Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University(Ningbo Yinzhou People's Hospital), Ningbo, Zhejiang, 315000, China.
| | - Yier Qiu
- Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University(Ningbo Yinzhou People's Hospital), Ningbo, Zhejiang, 315000, China
| | - Guowen Lu
- Thyroid and Breast Surgery, The Affiliated People's Hospital of Ningbo University(Ningbo Yinzhou People's Hospital), Ningbo, Zhejiang, 315000, China
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Davey MG, Browne F, Davey MS, Walsh SR, Kerin MJ, Lowery AJ. Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials. BJS Open 2023; 7:7055521. [PMID: 36821724 PMCID: PMC9949711 DOI: 10.1093/bjsopen/zrac170] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 11/17/2022] [Accepted: 12/06/2022] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND At present, there is no consensus on optimal neck wound closure methods after thyroid and parathyroid surgery. The aim of this study was to perform a systematic review and network meta-analysis of RCTs evaluating the optimal neck closure method after thyroid and parathyroid surgery. METHODS A frequentist random-effects network meta-analysis was performed for RCTs comparing at least two closure methods according to PRISMA-network meta-analysis guidelines. Analysis was performed using R packages and Shiny. RESULTS Eighteen RCTs evaluating six closure methods (that is adhesive (28.5 per cent, 404 patients), absorbable subcuticular suture (18.1 per cent, 257 patients), non-absorbable subcuticular suture (16.8 per cent, 238 patients), staples (26.3 per cent, 372 patients), steristrips (8.1 per cent, 115 patients), and conventional suture (2.1 per cent, 30 patients)) in 1416 patients were included. At network meta-analysis, there was no difference in complication, infection, dehiscence, or haematoma rates irrespective of closure method used. Staples reduced closure duration versus absorbable subcuticular suture (mean difference (MD) 8.50, 95 per cent c.i. 6.90 to 10.10) and non-absorbable subcuticular suture (MD 0.30, 95 per cent c.i. 0.23 to 0.37), whereas adhesives (MD -1.05, 95 per cent c.i. -1.31 to -0.79) reduced closure time relative to staples. Cosmesis was improved after non-absorbable subcuticular suture (odds ratio (OR) 3.41, 95 per cent c.i. 1.66 to 7.00) relative to staples. Staples reduced patient satisfaction (OR 0.04, 95 per cent c.i. 0.00 to 0.33) and ability to shower (OR 0.04, 95 per cent c.i. 0.00 to 0.33) relative to adhesives. CONCLUSION Despite staples decreasing closure times, this advantage is offset by reduced patient satisfaction, ability to shower, and cosmesis compared with patients with wounds closed using adhesives, absorbable subcuticular suture, and non-absorbable subcuticular suture. Therefore, these closure methods are favourable for closing neck wounds due to more acceptable patient-reported outcomes, without compromising the safety of the procedure.
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Affiliation(s)
- Matthew G Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Ferdia Browne
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Martin S Davey
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Stewart R Walsh
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Michael J Kerin
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
| | - Aoife J Lowery
- Discipline of Surgery, The Lambe Institute for Translational Research, National University of Ireland, Galway, Galway H91 YR71, Ireland
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Ilori OS, Olaitan PB, Ilori OR, Aderounmu AO. Patients’ satisfaction with the effects of microporous tape on surgical scars: a randomized controlled study. ARCHIVES OF AESTHETIC PLASTIC SURGERY 2022. [DOI: 10.14730/aaps.2022.00500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background Following surgery or other types of trauma, scar formation occurs with wound healing because of the replacement of normal skin with fibrous tissue. The conversion of a normal scar to an abnormal scar usually occurs 6 to 8 weeks after surgery. Abnormal scars can be a source of patient dissatisfaction, especially following cosmetic surgical procedures. Therefore, supporting scars with tape after surgery is critical for reducing scar tension. The aim of this study was to determine the extent of patients’ satisfaction with their scar outcomes following microporous taping and to identify the determinants of scar satisfaction.Methods A prospective randomized controlled study was conducted to compare the scar satisfaction of postsurgical patients who underwent scar taping with microporous tape to those who did not. The scars were assessed at 6 weeks, 3 months, and 6 months after surgery using the Patient Scar Assessment Scale (PSAS). The test group had microporous tape applied to their scars and the tape was worn 24 hours a day for a period of 6 months. The data were analyzed using SPSS version 22.0. Categorical variables and mean PSAS scores were compared using the chi-square test and repeated-measures analysis of variance, respectively.Results At 6 weeks, 3 months, and 6 months the taped group had significantly lower PSAS scores and higher satisfaction scores than the control group. Scar thickness and pruritus were statistically significant determinants of patient satisfaction.Conclusions Microporous tape is an effective modality for improving scar satisfaction in postsurgical patients.
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9
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Comparison of wound closure techniques after thyroid and parathyroid surgery: an updated systematic review and network meta-analysis. Updates Surg 2022; 74:1225-1237. [DOI: 10.1007/s13304-022-01296-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/01/2022] [Indexed: 10/18/2022]
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Raj M, Raj G, Sheng TK, Jsp L. Use of cyanoacrylate tissue adhesives for wound closure in the head and neck region: A systematic review. J Plast Reconstr Aesthet Surg 2021; 75:183-198. [PMID: 34657822 DOI: 10.1016/j.bjps.2021.08.015] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 06/08/2021] [Accepted: 08/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Wound closure in the head and neck region is challenging, primarily due to aesthetic concerns. Tissue adhesives have been prized for their ease of use. This study aimed to compare the effectiveness of tissue adhesives as a suitable alternative to other conventional wound closure techniques, in the head and neck region. METHODS A systematic review was conducted in line with PRISMA guidelines. Available English literature from 2009 to 2019 was reviewed from PubMed, Scopus and Google Scholar. Randomized controlled trials and controlled clinical trials with wounds in the head and neck region were included in this study. RESULTS Sixteen articles were found to meet the inclusion criteria. Main outcomes assessed included the following: cosmesis, pain, swelling, bleeding, wound dehiscence, time and cost. There was significant heterogeneity in results for pain, swelling and bleeding. No significant difference was observed in wound dehiscence and long-term cosmetic outcome when tissue adhesives were compared with sutures and staples. The time taken for wound closure with tissue adhesives was faster than sutures but were conflicted when compared with staples. Cost was found to be similar. CONCLUSION Overall, there is a consensus that there is no long-term difference in cosmetic outcome and wound dehiscence between tissue adhesives and other wound closure techniques. Tissue adhesives have the benefit of being easy and quick to use with excellent patient satisfaction levels. We recommend tissue adhesives as a suitable alternative for wound closure in low tension areas in the head and neck region.
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Affiliation(s)
- Mary Raj
- Dental Officer, National Dental Centre Singapore
| | - Grace Raj
- Dental Officer, National Dental Centre Singapore.
| | | | - Loh Jsp
- Discipline of Oral and Maxillofacial Surgery, National University Centre for Oral Health, National University Health System, Singapore
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Chung JH, Kim DS, Cheon JH, Yoon JM, Baek SK, Jung KY, Yoon ES, Park SH. Current Protocol for Aesthetic Scar Management in Thyroid Surgery. Laryngoscope 2021; 131:E2188-E2195. [PMID: 33567135 DOI: 10.1002/lary.29441] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 12/31/2020] [Accepted: 01/28/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS We compared the scar quality when different protocols were applied, and eventually aim to find the optimal scar management protocol. STUDY DESIGN We conducted a prospective, randomized, and blinded comparison of different scar management protocols in a single center. METHODS We allocated 126 patients who underwent thyroidectomy via collar neck incision randomly into three groups. Patients in group A were treated with tissue adhesive only. Patients in group B were treated by means of subcuticular suturing and early scar management with a non-ablative fractional laser (NAFL) and intralesional triamcinolone injection (ILI). Patients in group C had skin closure with tissue adhesive and early scar management. At 6 months after the operation, the Patient and Observer Scar Assessment Scale (POSAS) and the width of the final scar were compared. RESULTS Comparing the sum of PSAS, groups B and C showed significant higher satisfaction than did group A (22.81 ± 11.66 in group A, 10.9 ± 5.14 in group B, and 15.19 ± 9.98 in group C). In the sum of OSAS, group B also showed a significant difference than did groups A and C (17.74 ± 6.75 in group A, 10.26 ± 3.60 in group B, and 14.52 ± 6.48 in group C). Also, group B showed a narrower scar width than did groups A and C. CONCLUSIONS Our finding suggests that subcuticular suturing using barbed suture material and early treatment with a combination therapy using NAFL and ILI showed a favorable aesthetic outcome for both patients and operators. Based on our algorithmic approach for thyroidectomy scar, we anticipate an optimal aesthetic outcome. LEVEL OF EVIDENCE II Laryngoscope, 131:E2188-E2195, 2021.
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Affiliation(s)
- Jae-Ho Chung
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Da-Som Kim
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong-Hyun Cheon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Jeong-Min Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung-Kuk Baek
- Department of Otorhinolaryngology, Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Kwang-Yoon Jung
- Department of Otorhinolaryngology, Head and Neck Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Eul-Sik Yoon
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
| | - Seung-Ha Park
- Department of Plastic and Reconstructive Surgery, Korea University Anam Hospital, Seoul, Republic of Korea
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Tartaglia F, Giuliani A, Sorrenti S, Ulisse S. Minimally invasive video-assisted thyroidectomy and transoral video-assisted thyroidectomy: A comparison of two systematic reviews. J Minim Access Surg 2020; 16:315-322. [PMID: 32978350 PMCID: PMC7597888 DOI: 10.4103/jmas.jmas_123_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: We compared two systematic reviews, one focusing on transoral video-assisted thyroidectomy (TOVAT) and the other on minimally invasive video-assisted thyroidectomy (MIVAT), to highlight the pros and cons that can determine the choice of one or the other procedure. Materials and Methods: PubMed, Scopus and ISI Web of Science databases were searched for relevant articles published from 2000 to June 2018. Both searches were performed using the same keywords. All articles describing human surgical case series of any size were included, while the following were excluded: articles published in languages other than English, case reports, reviews, early cadaver and animal studies and old reports of cases now included in more recent works. Application of the above selection criteria yielded 151 articles on TOVAT and 246 on MIVAT. Of these, 34 articles were selected for inclusion in the present study: 17 for the TOVAT group and 17 for the MIVAT group. The comparison was made considering the most common variables used in evaluating thyroid surgery procedures. The statistical methods used were Cohen's delta, Student's t-test and the non-parametric Mann–Whitney U-test. Results: The variable 'operative time' was found to show a very large effect size, and 'hospital stay' also differed significantly between the MIVAT and TOVAT groups. Conclusions: TOVAT and MIVAT should not be considered in competition with each other, but seen simply as alternative choices. Both appear to be safe methods, comparable in terms of post-operative complications, although the main reason for using TOVAT seems to be purely aesthetic.
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Affiliation(s)
| | - Alessandro Giuliani
- Department of Environment and Health, Superior Institute of Health, Rome, Italy
| | - Salvatore Sorrenti
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
| | - Salvatore Ulisse
- Department of Surgical Sciences, 'Sapienza' University of Rome, Rome, Italy
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A Prospective Randomized Control Study Comparing the Effects of Dermal Staples and Intradermal Sutures on Postoperative Scarring After Thyroidectomy. J Surg Res 2020; 256:413-421. [PMID: 32791393 DOI: 10.1016/j.jss.2020.06.052] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2020] [Revised: 06/12/2020] [Accepted: 06/17/2020] [Indexed: 11/24/2022]
Abstract
BACKGROUND We compared cosmetic outcomes, pain intensity, and costs between dermal stapling and intradermal suturing in patients who underwent thyroidectomy through cervical incision. PATIENTS AND METHODS In total, 40 patients were randomly assigned to undergo thyroidectomy through a low cervical incision and dermal closure using either absorbable staples (n = 20, staple group) or interrupted intradermal sutures (n = 20, suture group). Wound complications, cosmetic outcomes (modified Stony Brook Scar Evaluation Scale [SBSES] and Manchester Scar Scale [MSS]), and pain intensity (visual analog scale) were assessed at 1, 4, 12, and 24 weeks postoperatively. The difference in total "wound-closure cost" between the two groups was also analyzed. RESULTS There were no wound-related complications and no significant differences in SBSES or MSS scores between the two groups (P = 0.609 and P = 0.141, respectively). However, the staple group had significantly higher SBSES scores, compared to the suture group, at 24 wk postoperatively (4.06 ± 0.94 versus 3.26 ± 1.24; P = 0.030, respectively); MSS scores were significantly lower in the staple group than in the suture group at 24 wk postoperatively (6.72 ± 1.27 versus 8.16 ± 2.17, respectively; P = 0.028). Visual analog scale scores were significantly lower in the suture group than in the staple group (P = 0.038). The total wound-closure cost was significantly higher in the staple group than in the suture group (137.10 ± 8.39 versus 81.79 ± 19.95 USD; P < 0.001). CONCLUSIONS When dermal staples were used, wound complications were absent and long-term cosmetic outcomes were superior; however, pain intensity was higher and the cost was greater, although healing was significantly more rapid, compared to intradermal sutures. Closure using absorbable dermal staples may be safe and effective for cervical incisions during thyroid surgery. Further studies with larger number of participants are needed to confirm our findings.
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Goto S, Sakamoto T, Ganeko R, Hida K, Furukawa TA, Sakai Y. Subcuticular sutures for skin closure in non-obstetric surgery. Cochrane Database Syst Rev 2020; 4:CD012124. [PMID: 32271475 PMCID: PMC7144739 DOI: 10.1002/14651858.cd012124.pub2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Following surgery, surgical wounds can be closed using a variety of devices including sutures (subcuticular or transdermal), staples and tissue adhesives. Subcuticular sutures are intradermal stitches (placed immediately below the epidermal layer). The increased availability of synthetic absorbable filaments (stitches which are absorbed by the body and do not have to be removed) has led to an increased use of subcuticular sutures. However, in non-obstetric surgery, there is still controversy about whether subcuticular sutures increase the incidence of wound complications. OBJECTIVES To examine the efficacy and acceptability of subcuticular sutures for skin closure in non-obstetric surgery. SEARCH METHODS In March 2019, we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies, and scanned reference lists of relevant included studies as well as reviews, meta-analyses and health technology reports to identify additional studies. There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA All randomised controlled trials which compared subcuticular sutures with any other methods for skin closure in non-obstetric surgery were included in the review. DATA COLLECTION AND ANALYSIS Two review authors independently identified the trials, extracted data and carried out risk of bias and GRADE assessment of the certainty of the evidence. MAIN RESULTS We included 66 studies (7487 participants); 11 included trials had more than two arms. Most trials had poorly-reported methodology, meaning that it is unclear whether they were at high risk of bias. Most trials compared subcuticular sutures with transdermal sutures, skin staples or tissue adhesives. Most outcomes prespecified in the review protocol were reported. The certainty of evidence varied from high to very low in the comparisons of subcuticular sutures with transdermal sutures or staples and tissue adhesives; the certainty of the evidence for the comparison with surgical tapes and zippers was low to very low. Most evidence was downgraded for imprecision or risk of bias. Although the majority of studies enrolled people who underwent CDC class 1 (clean) surgeries, two-thirds of participants were enrolled in studies which included CDC class 2 to 4 surgeries, such as appendectomies and gastrointestinal surgeries. Most participants were adults in a hospital setting. Subcuticular sutures versus transdermal sutures There may be little difference in the incidence of SSI (risk ratio (RR) 1.10; 95% confidence interval (CI) 0.80 to 1.52; 3107 participants; low-certainty evidence). It is uncertain whether subcuticular sutures reduce wound complications (RR 0.83; 95% CI 0.40 to 1.71; 1489 participants; very low-certainty evidence). Subcuticular sutures probably improve patient satisfaction (score from 1 to 10) (at 30 days; MD 1.60, 95% CI 1.32 to 1.88; 290 participants; moderate-certainty evidence). Wound closure time is probably longer when subcuticular sutures are used (MD 5.81 minutes; 95% CI 5.13 to 6.49 minutes; 585 participants; moderate-certainty evidence). Subcuticular sutures versus skin staples There is moderate-certainty evidence that, when compared with skin staples, subcuticular sutures probably have little effect on SSI (RR 0.81, 95% CI 0.64 to 1.01; 4163 participants); but probably decrease the incidence of wound complications (RR 0.79, 95% CI 0.64 to 0.98; 2973 participants). Subcuticular sutures are associated with slightly higher patient satisfaction (score from 1 to 5) (MD 0.20, 95% CI 0.10 to 0.30; 1232 participants; high-certainty evidence). Wound closure time may also be longer compared with staples (MD 0.30 to 5.50 minutes; 1384 participants; low-certainty evidence). Subcuticular sutures versus tissue adhesives, surgical tapes and zippers There is moderate-certainty evidence showing no clear difference in the incidence of SSI between participants treated with subcuticular sutures and those treated with tissue adhesives (RR 0.77, 95% CI 0.41 to 1.45; 869 participants). There is also no clear difference in the incidence of wound complications (RR 0.62, 95% CI 0.35 to 1.11; 1058 participants; low-certainty evidence). Subcuticular sutures may also achieve lower patient satisfaction ratings (score from 1 to 10) (MD -2.05, 95% CI -3.05 to -1.05; 131 participants) (low-certainty evidence). In terms of SSI incidence, the evidence is uncertain when subcuticular sutures are compared with surgical tapes (RR 1.31, 95% CI 0.40 to 4.27; 354 participants; very low-certainty evidence) or surgical zippers (RR 0.80, 95% CI 0.08 to 8.48; 424 participants; very low-certainty evidence). There may be little difference in the incidence of wound complications between participants treated with subcuticular sutures and those treated with surgical tapes (RR 0.90, 95% CI 0.61 to 1.34; 492 participants; low-certainty evidence). It is uncertain whether subcuticular sutures reduce the risk of wound complications compared with surgical zippers (RR 0.55, 95% CI 0.15 to 2.04; 424 participants; very low-certainty evidence). It is also uncertain whether it takes longer to close a wound with subcuticular sutures compared with tissue adhesives (MD -0.34 to 10.39 minutes; 895 participants), surgical tapes (MD 0.74 to 6.36 minutes; 169 participants) or zippers (MD 4.38 to 8.25 minutes; 424 participants) (very low-certainty evidence). No study reported results for patient satisfaction compared with surgical tapes or zippers. AUTHORS' CONCLUSIONS There is no clear difference in the incidence of SSI for subcuticular sutures in comparison with any other skin closure methods. Subcuticular sutures probably reduce wound complications compared with staples, and probably improve patient satisfaction compared with transdermal sutures or staples. However, tissue adhesives may improve patient satisfaction compared with subcuticular sutures, and transdermal sutures and skin staples may be quicker to apply than subcuticular sutures. The quality of the evidence ranged from high to very low; evidence for almost all comparisons was subject to some limitations. There seems to be no need for additional new trials to explore the comparison with staples because there are high-quality studies with large sample sizes and some ongoing studies. However, there is a need for studies exploring the comparisons with transdermal sutures, tissue adhesives, tapes and zippers, with high-quality studies and large sample sizes, including long-term assessments.
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Affiliation(s)
- Saori Goto
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Takashi Sakamoto
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Riki Ganeko
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Koya Hida
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
| | - Toshi A Furukawa
- Kyoto University Graduate School of Medicine/School of Public HealthDepartment of Health Promotion and Human BehaviorYoshida Konoe‐cho, Sakyo‐kuKyotoJapan606‐8501
| | - Yoshiharu Sakai
- Kyoto University HospitalDepartment of Surgery54 Shogoin‐Kawahara‐choSakyo‐kuKyotoKyotoJapan606‐8507
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Zhang J, Miller CJ, O'Malley V, Bowman EB, Etzkorn JR, Shin TM, Sobanko JF. Patient and Physician Assessment of Surgical Scars: A Systematic Review. JAMA FACIAL PLAST SU 2019; 20:314-323. [PMID: 29392275 DOI: 10.1001/jamafacial.2017.2314] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Importance Surgical scarring affects patients by distracting the gaze of onlookers, disrupting social interactions, and impairing psychosocial health. Patient and physician agreement regarding ideal scar characteristics is important in developing congruent expectations after surgery. Objective To summarize published studies assessing patient and physician ratings of surgical scars, rates of patient and physician agreement in scar assessment, and elements of cutaneous scar assessment that differ between patients and physicians. Evidence Review A literature search of Ovid/Medline, PubMed, and EMBASE was conducted from January 1, 1972, to August 1, 2015. Prospective studies comparing scars from different surgical techniques using at least 1 physician-reported and patient-reported scar measure were included. Strength of studies was graded according to the Oxford Centre for Evidence-Based Medicine guidelines. Findings The review identified 29 studies comprising 4485 patients. Of the 29 included studies, 20 (69%) were randomized clinical trials (RCTs), 5 (17%) were prospective, nonrandomized studies, and 4 (14%) were descriptive studies. Disagreement between patients and physician evaluation of scars occurred in 28% (8 of 29) studies, with only patients rating scar difference in 75% (6 of 8) of these cases. Patients were more likely to value scar depth while physicians were more likely to value scar pigmentation and relief. Conclusions and Relevance Methodologically rigorous studies that include clinician- and patient-reported scar outcomes are uncommon. Studies that incorporate subjective and objective scar grading reveal disagreement between patients and clinicians. Of the incision and wound closure techniques assessed, few affected patient- and clinician-reported outcomes, but the evidence remains weak and future studies are recommended.
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Affiliation(s)
- Junqian Zhang
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | | | | | - Eric B Bowman
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Jeremy R Etzkorn
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Thuzar M Shin
- Department of Dermatology, University of Pennsylvania, Philadelphia
| | - Joseph F Sobanko
- Department of Dermatology, University of Pennsylvania, Philadelphia
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Lee K, Ward N, Oremule B, Mani N. Optimal wound closure techniques for thyroid and parathyroid surgery: A systematic review of cosmetic outcomes. Clin Otolaryngol 2019; 44:905-913. [PMID: 31145548 DOI: 10.1111/coa.13382] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Revised: 05/14/2019] [Accepted: 05/28/2019] [Indexed: 12/01/2022]
Abstract
OBJECTIVES Cosmesis after surgical wound closure is an important outcome. This is relevant after thyroid and parathyroid surgery as anterior neck scars are visible and often of concern to patients. We aimed to investigate whether wound closure method influences cosmetic outcome in thyroid and parathyroid surgery, in particular using sutures, staples, steri-strips and glue. DESIGN We performed a systematic review of MEDLINE, PubMed, EMBASE, CINAHL and Cochrane focusing on wound cosmesis following thyroid and parathyroid surgery. Searches were conducted using combinations of the search terms: thyroid/parathyroid surgery, wound/skin closure and suture, staples, clips, glue and steri-strips, using appropriate MESH terms and Boolean operators. MAIN OUTCOME MEASURES Primary outcome was wound cosmesis. Secondary measures were also extracted. RESULTS Initial search found 304 papers and after systematic review, a total of 10 studies compared different closure methods and cosmetic outcomes. There were nine randomised controlled trials and one cohort study, with a total of 712 patients. Three studies compared staples vs glue; three compared sutures vs clips; two compared suture vs steri-strips and two studies for suture vs glue. In general, short-term cosmesis was better with subcuticular sutures compared to glue or clips, long-term cosmetic outcomes were not influenced by closure method. CONCLUSIONS We found closure with subcuticular suture or steri-strips produced superior short-term cosmetic outcomes. Although long-term cosmetic outcome is not influenced by closure method, given the superior cosmetic outcome and advantage of not needing removal, we recommend subcuticular sutures should be performed for wound closure in thyroid and parathyroid surgery.
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Affiliation(s)
- Kristina Lee
- Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
| | - Nicholas Ward
- Department of Otolaryngology, Royal Bolton Hospital, Manchester, UK
| | - Babatunde Oremule
- Department of Otolaryngology, Fairfield General Hospital, Manchester, UK
| | - Navin Mani
- Department of Otolaryngology and Head and Neck Surgery, Manchester Royal Infirmary, Manchester, UK
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Teoh LY, Chong SS, Hoh SY, Teoh MS, Ng KL. A comparison of aesthetic outcome between tissue adhesive and subcuticular suture in thyroidectomy wound closure in a multiracial country: A randomized controlled trial. Asian J Surg 2019; 42:634-640. [DOI: 10.1016/j.asjsur.2018.09.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Revised: 09/19/2018] [Accepted: 09/28/2018] [Indexed: 01/12/2023] Open
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Lee KH, Kim EY, Park CH, Park YL, Yun JS, Lee GY. Assessing cosmetic results after conventional thyroidectomy using the EASY-EYE_C: a double-blind randomized controlled trial. Ann Surg Treat Res 2017; 93:231-239. [PMID: 29184875 PMCID: PMC5694713 DOI: 10.4174/astr.2017.93.5.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2017] [Revised: 04/01/2017] [Accepted: 04/25/2017] [Indexed: 11/30/2022] Open
Abstract
Purpose The incidence of thyroid cancer is relatively high, especially in young women, and postoperative scarring after thyroidectomy is an important problem for both patients and clinicians. Currently, there is no available product that can be used for wound protection during thyroid surgery. We used the EASY-EYE_C, a new silicone-based wound protector. Methods We conducted a double-blind randomized controlled trial to assess the efficacy of the EASY-EYE_C with surgical scars. We studied 66 patients who underwent conventional total thyroidectomy or hemithyroidectomy performed by a single surgeon from August 2015 to June 2016. At 6-week follow-up, a single blinded physician observed the wounds to make clinical assessments using the Patient and Observer Scar Assessment Scale (POSAS), the Vancouver Scar Scale (VSS), and a modified Stony Brook Scar Evaluation Scale (SBSES). Results There were no significant differences by sex, age, type of surgery, body mass index, length of wound, incision site (from sternal notch), or thyroid weight, but the duration of operation was significantly shorter in the experimental group (E group). The e-group also had better POSAS scores than the control group (C group), with means of 43.2 (standard deviation [SD], ±15.9) versus 68.3 (SD, ±21.5), respectively (P < 0.05). The modified SBSES and VSS scores were similar to those from the POSAS. Conclusion In this study, all scores for evaluating outcomes were higher in the E group than in the C group. In addition, the operation time was significantly shorter in the E group. Therefore, the EASY-EYE_C may be useful for improving the cosmetic outcomes of conventional thyroid surgery.
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Affiliation(s)
- Kwan Ho Lee
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Eun Young Kim
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chan Heun Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Yong Lai Park
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ji Sup Yun
- Department of Surgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Ga Young Lee
- Department of Dermatology, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
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A paired comparison analysis of third-party rater thyroidectomy scar preference. The Journal of Laryngology & Otology 2016; 131:13-18. [PMID: 27917727 DOI: 10.1017/s002221511600952x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the length and position of a thyroidectomy scar that is cosmetically most appealing to naïve raters. METHODS Images of thyroidectomy scars were reproduced on male and female necks using digital imaging software. Surgical variables studied were scar position and length. Fifteen raters were presented with 56 scar pairings and asked to identify which was preferred cosmetically. Twenty duplicate pairings were included to assess rater reliability. Analysis of variance was used to determine preference. RESULTS Raters preferred low, short scars, followed by high, short scars, with long scars in either position being less desirable (p < 0.05). Twelve of 15 raters had acceptable intra-rater and inter-rater reliability. CONCLUSION Naïve raters preferred low, short scars over the alternatives. High, short scars were the next most favourably rated. If other factors influencing incision choice are considered equal, surgeons should consider these preferences in scar position and length when planning their thyroidectomy approach.
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