Scar Appearance and Patient Satisfaction after the Tear Trough Incision for External Dacryocystorhinostomy

Abstract

Background: Postoperative scar is the major disadvantage of external dacryocystorhinostomy (DCR). Modified incision should be performed to reduce postoperative scarring. Objective: To evaluate scar appearance and patient satisfaction after the tear trough incision for external DCR. Materials and Methods: The present study was a descriptive study with information collected by telephone survey and retrospective chart review. Patients that underwent external DCR over a period of eight years were enrolled and completed the validated Patient Scar Assessment Questionnaire (PSAQ). Scar appearance, consciousness, symptom, and satisfaction were determined. Patient demographics, surgical information, and postoperative scar evaluation using the Scar Cosmesis Assessment and Rating (SCAR) scale were obtained from the medical records. Results: Fifty-eight patients responded to the telephone interview with 71 DCR surgeries performed. The most common scar characteristic and symptom reported by patients was color mismatch in 11.3% of scars and itching in 15.5%. Scar evaluated by patients was invisible in 57.7% of scars, minimally visible in 40.8%, and moderately visible in 1.4%. Among all patients with noticeable scars, 92% of these made no attempt to conceal the scars. The average patient scar grade was 0.44 (scale 0 to 3). The majority (93.1%) of patients were very satisfied with the scar outcome. Of the 64 scars evaluated by physician using the SCAR scale, common scar characteristics were scar spread (40.6%), hypopigmentation (15.6%), and hypertrophic scar (12.5%). The scar evaluated by physician was invisible in 59.4% of scars, minimally visible in 34.4%, and moderately visible in 6.3%, with an average scar grade of 0.47 (scale 0 to 3). Conclusion: The tear trough incision for external DCR results in minimal postoperative scarring, providing a very high satisfaction rate in most patients. © JOURNAL OF THE MEDICAL ASSOCIATION OF THAILAND | 2020