Comment on “Patient Attitudes to Sternotomy and Thoracotomy Scars” by Crossland et al.

In a recent article by Crossland and associates, the authors compared patient attitudes to sternotomy and thoracotomy scars following surgery for congenital heart disease after a structured interview of 201 patients [[1]]. Significantly more patients with a thoracotomy reported undesired outcomes with regard to the surgical approach. The authors also state that studies comparing patients' opinions on procedural aspects were lacking.

We recently compared the cosmetic outcome of thoracotomy and sternotomy procedures following atrial septal defect closure in a subgroup of prepubescent female patients (age at operation was 6.0 ± 3.0 years) after 23 years of follow-up [[2]]. In contrast to Crossland et al. our questionnaire investigation clearly showed a subjective preference for a thoracotomy scar, as it can be hidden by suitable clothing: 76 % (thoracotomy, n = 72) vs. 39 % (sternotomy, n = 23) of the patients stated that the cosmetic result was excellent (p = 0.008). In another questionnaire analysis by Massetti et al. [[3]], 70.2 % and 21.2 % of patients after ASD closure through a right anterolateral thoracotomy stated that the cosmetic result was excellent or good, respectively (n = 57, all female, mean age at operation 21.5 years, mean follow-up 7 years). No awkwardness when naked/wearing a bathing suit was felt by 90 % in our study [[2]] and by 80.6 % in the study of Massetti et al. [[3]], while 56 % of the patients of Crossland et al. admitted to feeling embarrassed by the scar [[1]].

Crossland et al. investigated both male and female patients. In addition, the age at surgery of their patients varied, ranging from 0 - 55 years. In our opinion, the described cohort does not take the important subgroup of young female patients into account who clearly preferred a thoracotomy to a sternotomy in our follow-up study [[2]].

References

• 1 Crossland D S, Jackson S P, Lyall R, Hamilton J R, Hasan A, Burn J. et al . Patient attitudes to sternotomy and thoracotomy scars.  Thorac Cardiovasc Surg. 2005;  53 93-95
• 2 Bleiziffer S, Schreiber C, Burgkart R, Regenfelder F, Kostolny M, Libera P. et al . The influence of right anterolateral thoracotomy in prepubescent female patients on late breast development and on the incidence of scoliosis.  J Thorac Cardiovasc Surg. 2004;  127 1474-1480
• 3 Massetti M, Babatasi G, Rossi A, Neri E, Bhoyroo S, Zitouni S. et al . Operation for atrial septal defect through a right anterolateral thoracotomy: current outcome.  Ann Thorac Surg. 1996;  62 1100-1103