Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis

Abstract

Objective: to compare the postoperative esthetic and healing aspects of postectomy performed by different surgical techniques, based on the evaluation of different specialty expert professionals. Methods: prospective and randomized clinical trial enrolling 149 preschool children with a medical indication for circumcision, divided into three groups: postectomy with the hemostatic device Plastibell® (PB group), conventional technique (CV group) and conventional with subcuticular stitches (SC group). Pictures were taken from patients at pre-defined angles on the 30th and 60th postoperative days. Photos were evaluated by three specialists (dermatologist, pediatrician and plastic surgeon), who assigned scores from 1 to 5 regarding the esthetic and healing features at each moment. Grades 4 or 5 from all specialists characterized “best result”. Data were analysed to compare the used surgical techniques, the judgments from specialties and postoperative complications. Results: most of the patients obtained the “best result” regarding healing (70%) and esthetics (56%). The final overall result showed the PB group as the best for healing (p=0.028) and the SC group as the best for esthetics (p=0.002). For the dermatologist, on the 60th postoperative day, the CV group presented the worst aesthetic result, whereas for the pediatrician and the plastic surgeon, the PB group presented the best healing result and the SC group had the best esthetic result. There was no difference between the groups regarding the presence of complications. Conclusion: the most common surgical techniques used to perform postectomy in children were differently assessed regarding healing and esthetic features by distinct medical professionals. The analysis of these two parameters among experts from related areas diverged among them and over time.

Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis

“…However, according to Talini et al2 , there was no statistically significant difference between the complications arising from the different surgical techniques used in their service. Thus, there are no contraindications for the use of the Plastibell® device as for complications, it being the surgical technique with better healing results1 , second in aesthetics only to the subcuticular suture method.The study by Falcão et al¹ paves the way to new studies that highlight the importance of the healing and aesthetic process throughout the patients' lives. Moreover, one must contemplate the impact that may be caused by any aesthetic damage and, consequently, the assessment of possible harm to the patient's self-esteem depending on the surgical technique used, in addition to considering the frequency of each complication.…”

“…It was with extreme interest that we read the article “Postoperative aesthetic and healing features of postectomy using three different surgical techniques: a randomized, prospective, and interdisciplinary analysis”, published in the Journal of the Brazilian College of Surgeons 1 . The healing and aesthetic results are divergent mainly due to the large number of medical specialties able to perform this procedure, but clinical studies have shown the Plastibell® (PB) technique as being the best in terms of healing and the subcuticular (SC) technique as rendering the best aesthetic aspect, based on the scores assigned by specialists from three different medical fields (Pediatrics, Dermatology, and Plastic Surgery).…”

“…As seen, Plastic Surgery proved to be the most rigorous, with many scores below 3, showing the vision of a doctor who deals daily with the concept of “beauty” and with the judgment of patients who are there precisely in search of “perfection”. Pediatrics, on the other hand, appears as a specialty that is not as rigorous as for the esthetic and healing postoperative evolution, with the highest percentage of scores above 4 and 5 (90%) 1 .…”

“…However, according to Talini et al 2 , there was no statistically significant difference between the complications arising from the different surgical techniques used in their service. Thus, there are no contraindications for the use of the Plastibell® device as for complications, it being the surgical technique with better healing results 1 , second in aesthetics only to the subcuticular suture method.…”