title: Two-Step Incision for Periarterial Sympathectomy of the Hand.
abstract: BACKGROUND
  Surgical scars on the palmar surface of the hand may lead to functional and also aesthetic and psychological consequences. The objective of this study was to introduce a new incision technique for periarterial sympathectomy of the hand and to compare the results of the new two-step incision technique with those of a Koman incision by using an objective questionnaire.
  
  
  METHODS
  A total of 40 patients (17 men and 23 women) with intractable Raynaud's disease or syndrome underwent surgery in our hospital, conducted by a single surgeon, between January 2008 and January 2013. Patients who had undergone extended sympathectomy or vessel graft were excluded. Clinical evaluation of postoperative scars was performed in both groups one year after surgery using the patient and observer scar assessment scale (POSAS) and the Wake Forest University rating scale.
  
  
  RESULTS
  The total patient score was 8.59 (range, 6-15) in the two-step incision group and 9.62 (range, 7-18) in the Koman incision group. A significant difference was found between the groups in the total PS score (P-value=0.034) but not in the total observer score. Our analysis found no significant difference in preoperative and postoperative Wake Forest University rating scale scores between the two-step and Koman incision groups. The time required for recovery prior to returning to work after surgery was shorter in the two-step incision group, with a mean of 29.48 days in the two-step incision group and 34.15 days in the Koman incision group (P=0.03).
  
  
  CONCLUSIONS
  Compared to the Koman incision, the new two-step incision technique provides better aesthetic results, similar symptom improvement, and a reduction in the recovery time required before returning to work. Furthermore, this incision allows the surgeon to access a wide surgical field and a sufficient exposure of anatomical structures.
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Seung Bae
authors.initials: SB
authors.lastname: Jeon
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hanyang University Seoul Hospital, Hanyang University College of Medicine, Seoul, Korea.
authors.forename: Hee Chang
authors.initials: HC
authors.lastname: Ahn
authors.affiliation: START Plastic Surgery Clinic, Seoul, Korea.
authors.forename: Yong Su
authors.initials: YS
authors.lastname: Ahn
authors.affiliation: Department of Plastic and Reconstructive Surgery, Hanyang University Guri Hospital, Hanyang University College of Medicine, Guri, Korea.
authors.forename: Matthew Seung Suk
authors.initials: MS
authors.lastname: Choi
keywords: Raynaud disease; Sympathectomy