Interpreting Vascular Scars

Interpreting Vascular Scars

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Overview


Vascular scars can be very confusing to the uninitiated. No scar is pathognomonic of a particular operation, and almost endless permutations of scars can exist together. Often two geographically quite distant scars can relate to the same operation because a bypass graft may be tunnelled between them (in these cases, always palpate between the scars because sometimes grafts are tunnelled subcutaneously). Gradually you will build up pattern recognition; however, it is not always possible to guess the exact operation from the scars, especially if the patient has had multiple trips to theatre.


Neck


Oblique incision in line with anterior border of sternocleidomastoid:



  • Carotid endarterectomy.
  • Neck exploration for trauma.
  • Excision of carotid body tumour.
  • Carotid-subclavian bypass.

Transverse incision above clavicle extending medially over sternocleidomastoid:



  • Thoracic outlet decompression.
  • Subclavian access.

Chest


Median sternotomy:



  • Cardiac access, for example:

    • CABG.
    • Valvular replacements.

Infraclavicular transverse incision:



  • to expose the axillary artery.

Small stab incisions in the third or fourth intercostal spaces:



  • Endoscopic thoracic sympathetcomy.

Oblique incision in any of the left intercostal spaces:



  • to expose the descending thoracic aorta (e.g. thoracic aneurysm repair).

Abdomen


Long midline:


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Jul 1, 2016 | Posted by in CARDIOLOGY | Comments Off on Interpreting Vascular Scars

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