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All patients born with OA/TOF have at least one surgical scar, and many have multiple scars. The majority of newborns with OA/TOF are repaired via a thoracotomy approach, with a curved horizontal excision below the scapula or laporoscopic route, both of which minimise scar issues. However, adults with OA/TOF may have had one or more of a different surgical approach, including vertical thoracotomy scar or vertical substernal scar. Most will also have scars from previous chest drains and gastrostomy scars. Those who had long-gap OA may have multiple surgical scars, and may also have oesophagostomy and/or tracheostomy scars in the neck.

Keloid scars

Some with OA/TOF, as with all surgical procedures, will develop keloid scarring. These are raised, firm, itchy scars that can be unsightly.


The aim here is to see the scar slowly softening then flattening, but this can take many months. They also may recur post any treatment.

  • Silicone dressings such as dermatix or cicacare worn 24/7 for six months plus, washing underneath daily and changing dressings weekly.
  • Intralesional triamcinolone injections (usually done in dermatology in secondary care).
  • Pressure dressings (usually fitted and prescribed in secondary or tertiary care plastic surgery departments). (137)
  • Surgical excision of the scar is often commonly requested by patients, but keloid scarring returns in almost all cases after simple re-excision, unless accompanied by steroid injection into the area.

Tethered/depressed scars

These are scars in which adhesion/scarring in the collagen can cause the scar to lie below the surrounding skin. This may pose a cosmetic problem, but can also cause physical problems with sweat pooling in the scar triggering maceration or fungal infections due to the moist environment. Most adults with OA/TOF needed chest drains and gastrostomies during infancy and these frequently caused indented scars as these were closed with purse suturing.


Indented scars can be treated surgically, with subcision incision in the dermal plane or deeper undermining may be necessary. The scar could also be fully excised and refashioned surgically. However, recurrence of tethering can occur with both approaches and UK NHS funding for surgical management of these scars is usually not available. (138,139)

Unsightly scars

Some adults with OA/TOF may be distressed by the appearance of their scars even without the scars being abnormal, and these may limit their choice of clothing, activities and intimate relationships. This may be due to the number of scars they have, the quality of the scar (dog earring, stretching), patient skin characteristics (ethnicity, genetics, other skin disease), and whether the scar became infected or broke down during healing.


In some cases, these can be refashioned surgically to improve the appearance. However, this would usually require an individual funding request from the local clinical commissioning group (CCG) for referral to plastic surgery in the UK and may need to be a private referral.

Intraabdominal adhesions

Adhesions are bands of scar tissue which form (in this case) in the abdominal cavity after surgery. Over 95% of those who have abdominal surgery have adhesions, but for the great majority, they cause no problems unless further surgery in the abdomen is needed at a later stage. However, for a small minority, this can lead to bowel obstruction and chronic pain. The numbers of adhesions increase with increasing numbers of abdominal procedures a patient has undergone. These adhesions can cause symptoms years post surgery.


Unless there is bowel obstruction, there is no way to see these radiologically, and they are usually only found during later surgery.


Unless they are symptomatic, adhesions don’t need treatment. Even if they are symptomatic, treatment may not be a cure – around 10% to 30% have new adhesions formed by surgical adhesolysis. However, in patients with chronic pain or obstruction due to adhesions, most achieve some benefit from adhesolysis. (140)