Aesthetics in Thyroid Surgery: The Patient Perspective

Chaung, Katrina; Duke, William S.; Oh, Sun Jung; Behr, Amanda Y.; Waller, Jennifer L.; Daniel, Jeannie; Terris, David J.

doi:10.1177/0194599817711886

Cited by 28 publications

(23 citation statements)

References 43 publications

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“…Another aspect of importance after thyroid surgery, especially from the patient perspective, is the cosmetic appearance of the cervical scar. Using the validated POSAS tool, no difference in cervical scar cosmesis was found in the present trial, either from the patient or observer perspective.…”

Section: Discussioncontrasting

confidence: 53%

Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery

Senne¹,

Zein²,

Falch³

et al. 2018

British Journal of Surgery

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Background: Suturing the platysma muscle during wound closure after thyroid surgery is frequently described in the literature. There is no prospective evidence to support its use or benefit. The aim of this study was to evaluate how a platysma muscle suture influences initial postoperative pain following thyroid surgery.Methods: Patients were assigned randomly to receive a platysma suture or no platysma suture in this prospective, patient-blinded trial. The duration of follow-up was 6 months. The primary endpoint was wound-specific pain 24 h after thyroid resection. Secondary endpoints were intraoperative and perioperative analgesia requirement, postoperative pain and complications until postoperative day 14, and Patient and Observer Scar Assessment Score (POSAS) 6 months after surgery.Results: Forty-one patients were randomized to each group. Visual analogue scale scores for wound-specific pain were lower in patients without a platysma suture 24 h after surgery (mean(s.d.) 3⋅15(1⋅46) versus 2⋅17(1⋅41) in groups with and without suture respectively; P = 0⋅002). There were no differences in the perioperative and postoperative need for analgesics, postoperative wound complications or cervical scar cosmesis 6 months after surgery (mean(s.d.) POSAS 23⋅99(9⋅53) versus 26⋅51(8⋅69); P = 0⋅148). Conclusion:Omitting the platysma muscle suture after thyroid surgery resulted in less wound-specific pain initially, with no difference in postoperative wound complications or cosmetic results. Registration number: NCT02951000 (http://www.clinicaltrials.gov).

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Section: Discussioncontrasting

confidence: 53%

Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery

Senne¹,

Zein²,

Falch³

et al. 2018

British Journal of Surgery

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show abstract

“… 5 , 6 To combat scars, surgical procedures are designed to limited the visible impact of scars by a variety of techniques, including positioning scars in favorable, less visible locations, orienting scars parallel to Langer’s lines, and reducing scar length (eg, minimally invasive or endoscopic techniques). 7 , 8 Patients may decline surgery altogether or be driven toward noninvasive treatments due to scar concerns. More than 180,000 scar revisions are performed in the United States on an annual basis, 9 leading to patient discomfort, lost productivity, and cost.…”

mentioning

confidence: 99%

Force Modulating Tissue Bridges for Reduction of Tension and Scar: Finite Element and Image Analysis of Preclinical Incisional and Nonincisional Models

Kazmer

Eaves

2018

Aesthetic Surgery Journal

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BackgroundForce modulating tissue bridges (FMTB) represent a new class of combined wound closure and scar reduction device designed to optimize the tension milieu of the healing wound.ObjectivesEngineering analysis and testing in both intact skin and incisional models was undertaken to assess changes in tissue tension associated with device placement and compare to standard suture closure.MethodsNonlinear, large deformation finite element analyses (FEA) were performed to compare the strains applied to tissues with sutures and FMTB. In the incisional model, a freshly euthanized Yorkshire pig received full thickness cutaneous incisions followed by alternating closure with sutures and FMTBs. FMTBs were also applied to intact adult human skin after pattern application. In each of the experiments, photographs were taken preapplication and postapplication and the resultant dot grid pattern changes were analyzed by image recognition algorithms to calculate applied strains.ResultsFEA indicate compressive stresses at the tissue:suture interface on the order of 4000 mmHg and 20 mmHg at the tissue:FMTB interface. Strain analysis of the sutures and FMTBs applied in the incisional lab testing indicated imposed strains on the tissues of around 40%, with FMTBs providing 10% more compression than sutures and 25% more compression between the applied devices (P = 0.000057). In the longitudinal study, tension reduction of the order of 30% was maintained over the treatment period of 10 days to verify device efficacy.ConclusionsFMTBs provide wounds while simultaneously modulating skin tension and thus have the potential to improve scar appearance.

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“…Another objective of this study was to investigate whether casual observer race and gender identity influenced observer visual attention. Chaung et al 9 reported that nonwhite patients had measurably different perceptions of neck scars than white patients. In particular, nonwhite patients appeared to rate computer-generated neck scars harsher than their white counterparts.…”

Section: Discussionmentioning

confidence: 99%

“…8 Patients and observers across the spectra of age, sex, and race universally prefer shorter and thinner scars following neck surgery. 9 Interestingly, non-Caucasian patients tend to rate neck scars worse and penalize longer and thicker scars more when compared to Caucasians. 9 This may be related to predispositions of certain skin types to hypertrophic or keloid scarring as well as cultural differences in the perception of scarring given regional variation in the popularity of scarless surgical approaches.…”

Section: Introductionmentioning

confidence: 99%

“…9 Interestingly, non-Caucasian patients tend to rate neck scars worse and penalize longer and thicker scars more when compared to Caucasians. 9 This may be related to predispositions of certain skin types to hypertrophic or keloid scarring as well as cultural differences in the perception of scarring given regional variation in the popularity of scarless surgical approaches. 10,11 However, the reasons behind these differences are not fully understood.…”

Section: Introductionmentioning

confidence: 99%

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Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

et al. 2019

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Objective: Measure attentional distraction of neck scars after open neck surgery compared to transoral endoscopic thyroidectomy via a vestibular approach (TOETVA) or transoral endoscopic parathyroidectomy via a vestibular approach (TOEPVA) using eye-tracking technology.Methods: Casual observers viewed facial images of patients who underwent open neck surgery, TOETVA/TOEPVA, or no surgery (controls). An eye-tracking monitor recorded eye fixations in real time. Multivariate Hotelling's analysis followed by post-hypothesis testing compared fixation durations for predefined regions of interest, including the eyes, nose, mouth, neck, and remaining face between open neck surgery patients, transoral neck surgery patients, and controls.Results: One hundred forty observers completed the experiment. The majority of their attention was directed towards the central triangle (eyes, nose, mouth). On multivariate analysis, distribution of attention was significantly different on the faces of those who underwent open neck surgery versus TOETVA/TOEPVA (T 2 = 43.66; F[32,131] = 14.5389, P < .0001). Observers attended significantly more to the neck (0.20 seconds, P < .0001; 95% CI, 0.13, 0.26 s) and less to the peripheral face (−0.24 seconds, P = .0031; 95% CI, −0.39, −0.08 s) of open neck surgery patients. In patients who followed up months after surgery, significant differences persisted (T 2 = 13.97; F[3451] = 4.6377, P = .0033). By contrast, fixation patterns for TOETVA/TOEPVA patients were not significantly different from controls (T 2 = 5.59, F[31,186] = 1.8602, P = .1345). Observer race and gender did not significantly affect attention to neck scars.Conclusion: Scars following open neck surgery draw attention in casual observers. This attentional distraction is prevented in TOETVA/TOEPVA patients due to the absence of a scar, even months after surgery. Moreover, visual processing of TOETVA/TOEPVA patients' faces is similar to that of controls. These data support the effectiveness of transoral neck surgery in giving patients a cosmetic result that does not distract the attention of observers.

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Aesthetics in Thyroid Surgery: The Patient Perspective

Cited by 28 publications

References 43 publications

Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery

Randomized clinical trial of platysma muscle suture versus no suture for wound closure after thyroid surgery

Force Modulating Tissue Bridges for Reduction of Tension and Scar: Finite Element and Image Analysis of Preclinical Incisional and Nonincisional Models

Transoral neck surgery prevents attentional bias towards the neck compared to open neck surgery

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