Comparison of the effect of W-shaped and linear skin incisions on scar visibility in bilateral external dacryocystorhinostomy

Abstract

Metin Ekinci,1 Halil Hüseyin Çağatay,1 Gokcen Gokce,2 Erdinç Ceylan,3 Sadullah Keleş,4 Özgür Çakici,5 Mehmet Ersin Oba,1 Zeliha Yazar1 1Department of Ophthalmology, University of Kafkas, 2Department of Ophthalmology, Sarikamis Military Hospital, Sarikamis, Kars, 3Ophthalmology Clinic, Erzurum Training and Research Hospital, 4Department of Ophthalmology, University of Atatürk, Erzurum, 5Department of Ophthalmology, University of Mugla Sitki Kocman, Muğla, Turkey Background: The aim of this study was to compare the effect of W-shaped skin (WS) and linear skin (LS) incisions on cutaneous scar tissue formation in patients who have undergone bilateral external dacryocystorhinostomy. Methods: Sixteen patients (14 females and two males) with acquired bilateral nasolacrimal duct obstruction were included in this prospective, interventional comparative study. LS incision was applied to one side and WS skin incision to the other side. The skin incisions were assessed 6 months after each procedure by the patients themselves and by two ophthalmologists who were unaware of the skin incision shape and side. Scar tissue that was not recognized under the same light conditions and in the same room from a 100 cm distance was recorded as grade 1. Minimally visible scar tissue was assessed as grade 2, moderately visible scar tissue as grade 3, and easily visible scar tissue as grade 4. Results: The mean scar assessment scores recorded by the first ophthalmologist were 2.50±0.82 for the LS group and 1.25±0.45 for the WS group (P<0.001). The second ophthalmologist’s assessment scores were 2.25±0.86 for the LS group and 1.25±0.45 for the WS group (P<0.001). The mean patient self-assessment score for the incision scars was 2.44±1.03 for the LS group and 1.56±0.73 for the WS group (P<0.001). Conclusion: Compared with LS incision, WS incision resulted in less cutaneous scar tissue formation in patients who have undergone bilateral external dacryocystorhinostomy. Keywords: external dacryocystorhinostomy, skin, W-shaped incision, linear incision