Section of Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Medical Center, Chicago, IL, USA.
Cleft Palate Craniofac J. 2021 Nov;58(11):1376-1381. doi: 10.1177/1055665620984349. Epub 2020 Dec 30.
Children with craniosynostosis are vulnerable to stigmatization and social withdrawal. Cranial vault reconstruction (CVR) results in large bicoronal scars, which may trigger further insult to self-esteem and social outcasting. This study aimed to delineate determinants of patient scar self-consciousness, parental scar satisfaction, and parent satisfaction with their child's overall medical/surgical care.
A 14-item questionnaire was distributed to parents of 95 patients who underwent open CVR at our institution. Age at first surgery, race, hair type, typical style, number of surgeries, complications, and use of distractors were surveyed. Patient scar self-consciousness, parental scar satisfaction, and parent satisfaction with their child's overall medical/surgical care were also queried. tests and linear regressions were performed for binary and continuous variables, respectively.
Of 45 respondents, significant associations were found between: (1) complications and decreased parent scar satisfaction; (2) complications and decreased overall satisfaction with medical/surgical care, and (3) older age at time of initial surgery and decreased overall medical/surgical satisfaction. A significant association was found between parental scar satisfaction and overall medical/surgical satisfaction (β = 0.65, = .002). There was no significant association between parent scar satisfaction and parental-reported patient self-consciousness, or parental-reported patient self-consciousness and overall medical/surgical satisfaction.
Our results underscore the value of scar aesthetics in reconstructive goals. Advanced age and complications are important determinants of satisfaction. However, the lack of association between parent-reported patient self-consciousness and parental scar satisfaction suggests differences in aesthetic priorities between parents and children. Further studies may elucidate additional aesthetic considerations of CVR in ethnic/racial minorities.
颅缝早闭患儿易受到歧视和社交回避。颅盖重建（CVR）会导致宽大的双冠状瘢痕，这可能进一步损害自尊心并导致社会排斥。本研究旨在阐明患者瘢痕自觉意识、父母对瘢痕的满意度以及父母对其子女整体医疗/手术护理满意度的决定因素。
对在我院行开放式 CVR 的 95 例患者的家长发放了一份包含 14 个问题的调查问卷。调查了首次手术的年龄、种族、发质、发型、手术次数、并发症以及使用牵引器的情况。还询问了患者的瘢痕自觉意识、父母对瘢痕的满意度以及父母对其子女整体医疗/手术护理的满意度。对二分类变量和连续变量分别进行了卡方检验和线性回归分析。
在 45 名受访者中，以下因素之间存在显著关联：（1）并发症与父母对瘢痕满意度降低有关；（2）并发症与对整体医疗/手术护理的满意度降低有关；（3）初次手术时年龄较大与对整体医疗/手术满意度降低有关。父母对瘢痕的满意度与整体医疗/手术满意度之间存在显著关联（β=0.65，p=0.002）。父母对瘢痕的满意度与父母报告的患者自觉意识之间，以及父母报告的患者自觉意识与整体医疗/手术满意度之间均无显著关联。
我们的研究结果强调了瘢痕美观在重建目标中的重要性。年龄较大和并发症是满意度的重要决定因素。然而，父母报告的患者自觉意识与父母对瘢痕的满意度之间缺乏关联表明，父母和子女在审美优先级上存在差异。进一步的研究可能会阐明种族/少数民族患者 CVR 更多的美学考虑因素。
