Thomas Eduje, De Benedetti Lorenzo, Parente Giovanni, Di Mitri Marco, Cravano Sara Maria, D'Antonio Simone, Gargano Tommaso, Lima Mario
IRCCS, Department of Paediatric Surgery of Bologna, S.Orsola Policlinic, Bologna, Italy.
Aesthetic Plast Surg. 2024 Dec;48(23):5171-5179. doi: 10.1007/s00266-024-04101-2. Epub 2024 Aug 26.
Omphalocele (OM) is a congenital defect of the abdominal wall. The main goal of the surgical management is the survival of the neonate. However, the residual scar following the surgery can be extremely burdensome and negatively impact the quality of life (QoL) of these patients. The aim of this study is to assess the cosmetic results of the surgical treatment, the level of satisfaction of patients and surgeons, and the influence of the scar on the QoL of the patient.
We conducted an observational retrospective cross-sectional study collecting all data regarding patients born with OM, operated at our Centre between 1998 and 2021. The cosmetic results of the surgical repair were evaluated using the validated Patient and Observer Scar Assessment Scale (POSAS). The assessment of the quality of life determined by the presence of the scar was conducted using PedQL 4.0. At last, the patients were visited by two paediatric surgeons and a medical student, which then scored the cosmetic result of the scar. Statistical analysis was conducted with Spearman linear correlation and Mann-Whitney test. A P-value below 0.05 was considered statistically significant.
In our study, we included a total of 19 patients, with a mean of 12 years of age at the time of the evaluation. The parameters with the major influence on the patient's general opinion of the scar were stiffness, thickness, and irregularity. We discovered significant differences in median values of all scores between the giant OM group and the nongiant OM group, in favour of the latter. Finally, we found a low grade of concordance between PedsQL filled by parents and patients.
The POSAS scale is a valid, feasible, and reliable tool for the assessment of the aesthetic outcome of surgical procedures. The original size of the defect is the most important factor acting on the result. However, it is crucial that any decision on plastic surgery to improve the looks of the scar must be postponed to the adult age of the patient.
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脐膨出（OM）是一种先天性腹壁缺陷。手术治疗的主要目标是新生儿存活。然而，手术后的残留疤痕可能极其沉重，并对这些患者的生活质量（QoL）产生负面影响。本研究的目的是评估手术治疗的美容效果、患者和外科医生的满意度水平，以及疤痕对患者生活质量的影响。
我们进行了一项观察性回顾性横断面研究，收集了1998年至2021年在我们中心接受手术的所有OM患儿的相关数据。使用经过验证的患者和观察者疤痕评估量表（POSAS）评估手术修复的美容效果。使用儿童生活质量量表4.0（PedQL 4.0）评估疤痕对生活质量的影响。最后，由两位小儿外科医生和一名医学生对患者进行访视，然后对疤痕的美容效果进行评分。采用Spearman线性相关和Mann-Whitney检验进行统计分析。P值低于0.05被认为具有统计学意义。
在我们的研究中，共纳入19例患者，评估时的平均年龄为12岁。对患者对疤痕总体评价影响最大的参数是硬度、厚度和不规则性。我们发现巨大脐膨出组和非巨大脐膨出组所有评分的中位数存在显著差异，非巨大脐膨出组更具优势。最后，我们发现父母和患者填写的儿童生活质量量表（PedsQL）之间的一致性较低。
POSAS量表是评估手术美学效果的有效、可行且可靠的工具。缺损的原始大小是影响结果的最重要因素。然而，至关重要的是，任何改善疤痕外观的整形手术决定都必须推迟到患者成年后。
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