Pediatric Cardiac Surgeon Minimizes Scarring

The surgery was a success: there were no complications, the pain was gone, the heart was repaired. The young patient returned to a regular childhood. Eventually, the memory of the surgery would fade. Right?

Yes, except for the large scar that would remain a visible reminder of the operation. Seeing that scar every day might seem like a small price to pay for a new lease on life. But surgical innovator Khanh H. Nguyen, MD, Associate Professor of Cardiothoracic Surgery and Chief of Pediatric and Congenital Heart Surgery, doesn't agree.

Axillary Incision Technique: Healing Patients' Self-Esteem

Surgery for congenital heart disease has become so effective that many more children are living longer, healthier lives well into adulthood. But Dr. Nguyen wanted to go beyond helping his patients' physical health. He wanted to make sure that their psychological well-being and self-esteem were preserved, as well.

Dr. Nguyen researched options to minimize scarring. He found one that caused less trauma to tissues and muscles in the chest: The axillary incision technique. This less invasive procedure is sometimes used to repair congenital heart defects in adults.

Traditional open-heart surgery requires an incision in the front of the chest. The breastbone is split in half, and the entire ribcage is pulled open with retractors. This method allows surgeons full access to the heart but leaves a long scar down the middle of the chest. The scar gets worse as young skin and muscles stretch as they grow.

Using the axillary technique, surgeons can access the heart with a much smaller incision under a patient's armpit. Incisions typically measure about 1.5 inches in a 22-pound infant to about 3 inches in adults. Less trauma means a hospital stay in some cases as short as 24 hours, says Ira Parness, MD, Professor of Pediatrics and Chief of the Division of Pediatric Cardiology. This allows patients to recover in comfortable, familiar surroundings.

"This is an amazing innovation," says Dr. Parness. "Dr. Nguyen is a spectacular pediatric cardiac surgeon. He is the first, and only, surgeon in the entire world to perform pediatric congenital heart surgery from the underarm."

Bruce Gelb, MD, Professor of Cardiology and Professor of Genetics and Genomic Sciences, agrees. "It is amazing to see a child who has gone through this surgery. You cannot find the scar until the kid lifts up his or her arm. That is pretty remarkable."


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