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

Abstract

IMPORTANCE Incision placement and design in rhytidectomy is critical for patient satisfaction.OBJECTIVE To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) trichophytic closure techniques on posterior occipital hairline scars in rhytidectomy. DESIGN, SETTING, AND PARTICIPANTSA retrospective cohort study was conducted at the Buckingham Center for Facial Plastic Surgery. Clinical history and operative reports were reviewed for 46 patients who underwent rhytidectomy (23 using W-plasty and 23 using SL technique) between June 1, 2014 and August 31, 2015. Blinded photographic analysis of 1-year postoperative photographs was performed. INTERVENTIONS The posterior occipital hairline incision was primarily closed with either a W-plasty or SL trichophytic technique.MAIN OUTCOMES AND MEASURES Standard photographs of the posterior occipital incision site obtained after the 1-year postoperative mark were reviewed and scored in a blinded fashion by 3 nonphysician medical staff members using a modified Manchester Scar Scale (MSS: from 0 [best possible outcome] to 24 [worst possible outcome]). Interrater reliability was assessed via Cronbach α testing. RESULTS There were 23 patients in each group. The W-plasty and SL groups were similar in terms of age (mean [SD] age, 59.6 [6.3] years and 64.1 [7.3] years, respectively), sex (21 [91%] and 21 [91%] women, respectively), race-ethnicity, and absence of risk factors (smoking and diabetes) predisposing to poor wound healing (0 and 0 smoking/diabetes, respectively). Mean (SD) follow-up times for the W-plasty and SL groups were 388 (38.8) and 475 (100.1) days, respectively. No statistical difference was demonstrated in the mean aggregate MSS scores from all evaluators between the W-plasty group and the SL group (reviewer 1: 5.69 vs 5.86, P = .60; reviewer 2: 10.09 vs 9.56, P = .65; and reviewer 3: 5.30 vs 6.17, P = .08). Overall interrater reliability for the MSS scores was 0.56.CONCLUSION AND RELEVANCE Primary W-plasty and SL trichophytic closures in the posterior occipital hairline appear to yield highly acceptable and similar cosmetic outcomes under objective blinded evaluation. These techniques can be used with success to help minimize conspicuous scarring after rhytidectomy.LEVEL OF EVIDENCE 3.

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

“…Some studies have found that the W‐plasty technique is significantly better than SL resection, and other studies have shown that there is no statistical difference between the two methods of skin closure. 4 , 8 , 9 In our previous study, we confirmed that the technique of CTR with a tension offloading device could effectively decrease the tension across the surgical incision and significantly reduce the keloid recurrence rate and achieve therapeutic efficacy. 13 In the research presented here, we first introduce the concept of CTR into traditional W‐plasty, aiming to overcome the drawbacks of using W‐plasty technology alone.…”

“…The literature reports and the results of this study show that although the SL incision combined with CTR technique can make the incision scar very thin, it is still unsatisfactory. 4 , 7 , 18 In contrast, W‐plasty had a camouflaging effect in relation to RSTLs. After surgery, a ‘broken‐line’ or accordion appearance allows the scar to break down into smaller triangles with at least one side parallel to a poorly defined RSTL, which causes light scattering and leads to a scar that is less noticeable to observers.…”

“…Scar revision is an important technique for creating a scar with a better tissue quality that is cosmetically and functionally more acceptable. 3 , 4 …”

“…W‐plasty redirects the forces of contracture, converting the lines of distraction from perpendicular to oblique and relieving the bowstringing effect of linear scars. 1 , 3 , 4 However, W‐plasties cannot prevent tension across an incision and a certain width of tissue must be given up in the revision procedure. In the early stages of wound healing, if the newly formed matrix deposition does not withstand physiologic mechanical stimulation, force equilibrium across the wound may be disrupted.…”

The Rhytidectomy Scar: Analysis of Patient and Surgeon Perspectives

“…For unfavorable scar healing, treatment options such as dermabrasion, laser, interlesional injections, and surgical scar revisions can be performed at a later time. While this study does not analyze the post-auricular incision, there are recommended techniques on incision placement to maximize aesthetic outcomes and minimize wound tension, such as but not limited to using W-plasty along the occipital hairline 6 and avoiding incision placement within the post-auricular sulcus. 7…”