The perception of scar cosmesis following thyroid and parathyroid surgery: A prospective cohort study

• Scar-related issues are not uncommon following thyroid and parathyroid surgery.
• No correlation was found between scar length and patient satisfaction.
• The perception of an acceptable cosmetic result differs between patient and clinician.
• Asian and Afro-Caribbean ethnicity and a malignant diagnosis were associated with a poor cosmetic outcome.
• The majority of patients would choose to avoid a neck scar given the option.

IntroductionVarious “scarless” approaches have been described for thyroid and parathyroid surgery. The objective of the current study was to investigate patients' perception of neck scar cosmesis, its impact on quality of life (QoL) and evaluate patient preference with regards to scar location.Methods120 patients undergoing thyroid or parathyroid surgery were followed-up over a 5-year period (2008–2013). Validated tools were used to assess scar perception and its impact on QoL. These were evaluated against sex, age, ethnicity, operation type, histopathology, time following surgery and scar length.ResultsMean follow-up was 2.6 ± 3.8 years. One of the most common post-operative problems was scar-related (n = 18). Caucasian patients and those with benign histology expressed a lower impact on QoL (p < 0.001, p = 0.038). Sex and scar length did not significantly affect patients' perception for scar cosmesis (p > 0.05). Clinicians tended to score scar cosmesis higher than patients (p = 0.02). Most participants (75%) expressed a clear preference for an extracervical “scar-less in the neck” approach.DiscussionScar-related issues are frequently reported following thyroid and parathyroid surgery. The negative impact, often underestimated by clinicians, is more apparent amongst Asian and Afro-Caribbean patients and can significantly impact on their QoL. This, combined with the lack of correlation between scar length and patient satisfaction, indicates the need to divert research from miniaturising neck scars to concealing them in extracervical sites.ConclusionPatients prefer a scar-less in the neck approach when given the option. A prospective comparative study is required to compare the cervical and extracervical approaches.