Skin Deep: Perception of Scars After Cranial Vault Reconstruction

Purpose: 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.

Methods: 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. T tests and linear regressions were performed for binary and continuous variables, respectively.

Results: 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, P = .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.

Conclusions: 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.