Comparison of cosmetic effects after short longitudinal and transverse skin incision for carotid endarterectomy
Abstract
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 asses sed 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.