Cosmetic effects of skin-crease camouflage incision versus longitudinal incision following carotid endarterectomy.

Abstract

IntroductionDespite the increasing use of carotid angioplasty and stenting (CAS), carotid endarterectomy (CEA) nonetheless remains a more medically beneficial method of treatment for carotid artery stenosis. Therefore, one possibility for progress within this procedure may be to use minimally invasive carotid surgery, especially when the scar is in plain sight: the use of the natural wrinkles (skin crease) as a camouflage of the skin incision provides significant cosmetic improvements.AimTo compare the cosmetic effects of classic and trans-wrinkle CEA. To assess the distance between the carotid artery bifurcation (CAB) and the skin-crease incision whilst attempting CEA.Material and methodsIt was a randomized prospective study with two groups: patients undergoing classic surgery (control group; n = 100) and skin-crease trans-wrinkle camouflaged CEA (study group; n = 100). Follow-up was at 2 months and 1 year.ResultsThe medical results of the treatment were similar in both groups. The cumulative count of strokes and myocardial infarctions was 0.5% within 30 days, and after one year 3.5% (and 5.5% including cases of death). The superiority of the transverse crease being hidden compared to the conventional longitudinal technique was proven in the Patient and Observer Scar Assessment Scale (POSAS) score, respectively 11.4 ±1.0 vs. 14.1 ±3.4 (p = 0.0001) after 2 months and 13.5 ±2.8 vs. 14.1 ±3.4 (p = 0.039) after a year.ConclusionsTrans-wrinkle incision gives better cosmetic results, can be safely performed in most cases, and offers a comfortable approach during CEA.

High Mini-Skin Incision during Carotid Endarterectomy for Carotid Stenosis

“…To decrease neurologic deficits and improve cosmetic effects, some centers have used minimal longitudinal incisions in a conventional manner, with or without sonographic assistance [2,6]. Furthermore, transverse incisions camouf laged in a skincrease have also been investigated [3,[7][8][9]. Studies of vertical incisions in CEA have shown that a minimal incision causes fewer local neurologic complications than a conventional incision, but no statistical differences have been observed in the incidence of stroke and death [2,6,10].…”

Nonpalmar Endoscopic versus Open Trigger Finger Release: Results from a Prospective Trial

“…The POSAS SDs in studies previously published on carpal tunnel release and carotid endarterectomies range from 1.0 to 11.0. 19 , 20 To detect a mean difference in POSAS score of 10 points (SD = 8) with a two-sided significance level of 5% and power of 80% with equal allocation to two arms required 12 patients in each arm of the trial.…”

Surgical Technique for Carotid Endarterectomy: Current Methods and Problems

“…3B ). 11 , 13) Kazimierczak et al 14) reported a randomized study of camouflage (transverse) incision versus longitudinal incision. Although no significant difference in mortality or morbidity was seen between groups, scar assessment scale score was significantly better in patients with camouflage incision than in patients with longitudinal incision.…”

“…Although no significant difference in mortality or morbidity was seen between groups, scar assessment scale score was significantly better in patients with camouflage incision than in patients with longitudinal incision. 14) However, if stenosis of the ICA extended to a high position, the transverse incision was limited to exposing the distal side of the ICA, and most surgeons use an extended longitudinal skin incision to improve distal ICA exposure ( Fig. 3C ).…”