title: The role of neck wrinkles for cosmetic effect during carotid artery endarterectomy.
abstract: BACKGROUND
  Minimally invasive procedures in carotid endarterectomy are currently preferred. Smaller skin incisions (transverse or longitudinal) and the mapping of carotid artery bifurcation with Doppler ultrasound are promoted. There is a lack of papers about cosmetic effects and patients' preferences. The aim of this study was to qualify natural skin wrinkles as potential anatomical markers of carotid artery bifurcation and scar camouflage.
  
  
  METHODS
  50 patients underwent carotid endarterectomy in 2013-2014 in the Vascular Surgery Department of the Pomeranian Medical University in Szczecin. The positions of wrinkles were compared with the anatomical location of carotid artery bifurcation with the use of Doppler - Duplex Ultrasound. Patients' preferences and cosmetic effect were also assessed.
  
  
  RESULTS
  50% of patients declared the cosmetic effect important. Nevertheless, every patient preferred a transverse incision along a wrinkle line. The wound scar was invisible in 76% of cases 3-6 months after surgery. Wrinkles were close, within 1 centimeter, to carotid artery bifurcation in 80% of cases. It was mainly 4-5 cm from the angle of the mandible. Surgical access along wrinkles located 3, 4, 5, 6, 7 cm from the gonial angle was technically easy in 55%, 77%, 79%, 45%, and 21% of cases, respectively. Using ultrasound before surgery allows the planning of the optimal incision in 98% of cases.
  
  
  CONCLUSIONS
  Transverse incision hidden in the wrinkles of the neck gives a good cosmetic effect and allows carotid endarterectomy in every case when carotid artery bifurcation is marked prior to surgery.
authors.forename: Arkadiusz
authors.initials: A
authors.lastname: Kazimierczak
authors.forename: Anita
authors.initials: A
authors.lastname: Rybicka
authors.forename: Paweł
authors.initials: P
authors.lastname: Szumiłowicz
authors.forename: Piotr
authors.initials: P
authors.lastname: Gutowski
authors.forename: Halina
authors.initials: H
authors.lastname: Kupicz
authors.forename: Rabih
authors.initials: R
authors.lastname: Samad
authors.forename: Tomasz
authors.initials: T
authors.lastname: Zakrzewski
authors.forename: Marcin
authors.initials: M
authors.lastname: Sledź
mesh_terms: D002921:Cicatrix / Q000517:prevention & control*; D062109:Dermatologic Surgical Procedures; D016894:Endarterectomy, Carotid / Q000379:methods*; D006801:Humans; D019060:Minimally Invasive Surgical Procedures; D009333:Neck / Q000601:surgery*; D057240:Patient Preference; D015595:Skin Aging / Q000502:physiology*