Current Protocol for Aesthetic Scar Management in Thyroid Surgery

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.

Optimal primary wound closure methods after thyroid and parathyroid surgery: network meta-analysis of randomized clinical trials

“…1 ) 34–51 . In these studies, there were data from 1416 patients and six closure methods (that is adhesive (28.5 per cent, 404 patients, 10 RCTs) 35–38 , 40 , 42 , 44 , 45 , 49 , 50 , absorbable subcuticular suture (ASCS) (18.1 per cent, 257 patients, 7 RCTs) 35 , 37 , 39 , 41 , 44 , 47 , 50 , non-absorbable subcuticular suture (NASCS) (16.8 per cent, 238 patients, 6 RCTs) 34 , 43 , 46 , 48 , 49 , 51 , staples (26.3 per cent, 372 patients, 11 RCTs) 34 , 36 , 38 , 40–43 , 45–47 , 51 , steristrips (8.1 per cent, 115 patients, 3 RCTs) 39 , 46 , 48 , and CS (2.1 per cent, 30 patients, 1 RCTs) 51 . Of the 18 RCTs included in this analysis, 44.4 per cent were conducted in European surgical research institutions (8/18) 35–37 , 39–43 .…”

“…Fourteen RCTs described patient-reported cosmesis after thyroid and parathyroid surgery 34–40 , 43–45 , 47 , 49 , 50 . Overall, 73.6 per cent of patients were satisfied with their cosmesis after operation (134/182); 85.1 per cent (80/94) and 61.4 per cent (54/88) of those who had NASCS and staples for wound closure respectively were satisfied with the cosmetic outcome of their wound ( Table 3 ).…”

Cyanoacrylate Tissue Adhesives Compared With Sutures on Facial and Neck Wounds: A Meta‐analysis

“…Finally, the full text of 49 studies was reviewed. Eighteen articles 33,36‐52 were included in the qualitative synthesis, of which 17 33,36‐47,49‐52 were included in the quantitative synthesis. Figure 1 shows the flowchart of study retrieval and selection 22 …”

“…Finally, the full text of 49 studies was reviewed. Eighteen articles 33,[36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52] were included in the qualitative synthesis, of which 17 33,[36][37][38][39][40][41][42][43][44][45][46][47][49][50][51][52] were included in the quantitative synthesis. Figure 1 shows the flowchart of study retrieval and selection.…”

“…The wounds were located on the face (8 studies), 33,[36][37][38][39][40]46,48 the neck (6 studies), 43,45,47,[50][51][52] and both the face and neck (4 studies). 41,42,44,49 In the CTA group, butylcyanoacrylate (n-2-butyl, butyl, n-butyl) was applied in 4 articles, 36,38,49,51 octylcyanoacrylate (octyl-2, octyl) in 10 articles, 37,[39][40][41][42][43][44][45]47,48 ethylcyanoacrylate in 1 article, 33 a combination of butylcyanoacrylate (N-butyl, N-butyl-2), and octylcyanoacrylate (octyl-2) in 2 articles. 46,50 The type of CTA was not mentioned in 1 article.…”