An Analysis of Pediatric Scar Progression Over Time.

Objective: The advances in surgical approaches for a pyloromyotomy have all focused on creating smaller incisions from a right upper quadrant now to a laparoscopic umbilical incision. A key assumption is that the final scar retains the size of the original incision as the child matures. Our case reports on a family with several members, now adults, with the same surgery and same surgeon who had the right upper quadrant incision as infants to elucidate the extent of how infantile scars grow over time, significantly exceeding the original incision. Methods: We evaluated the various pyloromyotomy scars of our newborn patient, his maternal grandmother, and his two maternal twin aunts. One aunt (#1) was of normal stature, whereas her twin (#2) never went through a full vertical growth phase due to being stunted by Cornelia de Lange syndrome. For each member, we compared the length of the original incision with the current scar length to determine how much the scar has grown over time. Results: Significant scar growth was seen in the grandmother and aunt 1. In contrast aunt 2's scar did not grow significantly due to her stunted vertical growth from Cornelia de Lange syndrome. Conclusions: This case supports the notion that surgical incisions in infants grow more substantially than realized with age, resulting in larger scars than anticipated. Our findings suggest the reason why the laparoscopic pyloromyotomy has been popularized due to its incisions being so small that they continue to present a cosmetic advantage over time.