Older Patients and Patients with Severe Arteriosclerosis Are Less Likely to Develop Keloids and Hypertrophic Scars after Thoracic Midline Incision: A Survey-Based Analysis of 328 Cases.
Level 3 - non-randomized controlled study
Retrospective cohort study evaluating risk factors with comparison groups
PubMed 35787599 · doi:10.1097/PRS.0000000000009451
What was done
A retrospective survey-based cohort study evaluated consecutive Japanese adults (aged 18 or older) who underwent cardiovascular surgery with sternotomy between 2014 and 2017. In 2019, 548 identified patients were mailed a questionnaire containing photographs of mature, keloid, and hypertrophic scars to self-classify their midline scar. The authors assessed the incidence of self-reported pathologic scarring (keloids and hypertrophic scars combined) and tested associations with age, sex, and carotid intima-media thickness.
What was found
A total of 328 of 548 patients responded (60% response rate; mean age 67 years; 68.0% male). Pathologic scarring was reported by 195 patients (59.5%). Compared to patients reporting mature scars, those with pathologic scars had a significantly younger mean age (65 vs. 69 years; p = 0.0002) and significantly lower mean intima-media thickness (0.92 vs. 1.05 mm; p = 0.028).
Why it matters
Sternotomy wounds exhibit a high rate of pathologic scarring, and younger age alongside lower arterial intima-media thickness appears to increase risk. This provides insight into patient-specific vascular and age-related factors influencing abnormal scar formation under tension.
Limits
Scar outcomes were self-reported from reference photos rather than evaluated through in-person clinician examination. The 40% non-response rate introduces potential selection and recall bias. Keloids and hypertrophic scars were grouped together, and the study was limited to Japanese cardiovascular surgery patients.
Cited by
- supports Younger patients in their 20s and 30s have a higher risk of developing thicker surgical scars than patients in their 60s or 70s due to more robust collagen production.