FACTORS AFFECTING HYPERTROPHIC SCAR DEVELOPMENT IN MEDIAN STERNOTOMY INCISIONS FOR CONGENITAL CARDIAC-SURGERY

Background: Even after successful operations on children, unattractive postoperative scars are often distressing to patients and their paren ts, There are no reports about the factors affecting keloid or hypertr ophic scar (HS) development after congenital cardiac Surgery. Study De sign: Postoperative scars were studied in 75 patients 3 months after c ongenital cardiac surgery by median skin incision, The mean age of the 51 males and 24 females was 2.7 +/- 2.3 years (range, 2 days - 12 yea rs), The scars were evaluated according to degree of redness, expresse d as redness score, and skin blood flow, as measured by laser Doppler imaging, Skin blood flow ratio was calculated as blood flow at the sca r divided by blood flow below the navel. After surgery, 40 patients re ceived 5 mg/kg/day of tranilast, which inhibits the collagen synthesis of keloid fibroblasts. Results: None of the 75 patients had keloid fo rmation and 21 (28%) developed HS after operation. Mean age of patient s with HS (HS (+) group) was 4.4 +/- 3.3 years and that of patients wi th no HS development (HS (-) group) was 1.5 +/- 1.9 years (p < 0.01), There were no significant differences between these two groups in gend er or in pre-or postoperative cyanosis, Hypertrophic scar (+) patients exhibited significantly higher skin blood flow ratios than HS (-) pat ients (2.7 +/- 1.3 versus 1.4 +/- 0.6; p < 0.001), Hypertrophic scar w as seen in 11 of 40 tranilast administered patients (28%) and in 10 of 34 patients not receiving tranilast (29%) (NS), Hypertrophic scar was less apparent in the patients who received tranilast versus those who did not; redness scores were 29.5 +/- 16.5 and 51.6 +/- 14.9, respect ively (p < 0.01). Conclusions: These data suggest Chat age and skin bl ood flow ratio were the factors affecting HS development. postoperativ e use of tranilast did not affect the frequency of HS development but did reduce its redness.