Comparison Efficacy of Onion Extract plus Heparin with Flucinolone Acetonide on Midsternotomy Hypertrophic Scars Following Open Heart Surgery

Background. Post-midsternotomy hypertrophic scars can lead to remarkable morbidities such as pigmentation alteration, pain, tenderness, induration, itching, and erythema so that they may be cosmetically and emotionally unacceptable to the patient undergoing midsternotomy. Initially, wound healing is induced rapidly with re-epithelialization, whereas tissue remodeling occurs several months later to create a regular scar. This study was undertaken to evaluate the efficacy of onion extract plus heparin versus Fluocinolone acetonide on scar formation after midsternotomy in patients who are candidates for coronary bypass graft (CABG) surgery. Materials and Methods. One hundred patients undergoing off- pump coronary artery bypass graft (CABG) surgery were randomly assigned into two groups, group A, onion extract plus heparin (n=50), and group B, flucinolone acetonide (n=50). After performing midsternotomy for accessing to intra-chest cavity, the target vessel was exposed and snared above the anastomosis site with zero to four sutures and a soft plastic snugger was applied to prevent coronary injury. A skilled surgeon sutured incisions of the midsternotomy. The topical treatments (gel) were started one week post operation. Subjects were then asked to return to cardiovascular center three months after the surgery for evaluation of their wounds and condition of their scars. The postoperative parameters such as indurations, erythema, pigmentation alteration, itching, cosmetic appearance, raised area of the incision, tenderness, sternal wound infection, and duration of incision improvement were evaluated by method of Vancouver scar scale. Results. The average age of all the patients was 63.8±11, 63±11.5 was related to fluocinolon acetonide group (FA) and 64±10 related to onion extract plus heparin group (OEH). Postoperative rise in scar area was observed in 63 cases, 28 cases (56%) in OEH and 35 cases (70%) in FA (p=0.14). Postoperative erythema and itching had not significant differences in both groups, therefore, onion extract plus heparin could not diminish these complications after open heart surgery (p>0.05). Conclusion. Onion extract plus heparin significantly decreased pigmentation alternation, duration of incision improvement, and tenderness after midsternotomy.