Totally Implantable Venous Access Devices in Children with Cancer Lead to Disfiguring Scars

Background: In pediatric cancer patients scars of totally implantable venous access devices (TIVAD) are often widened and hypertrophic. This study report on the prevalence and deviation of abnormal scarring in children with a TIVAD and to describe the influencing factors for this abnormal scarring. Methods: In a cross-sectional study scars of 122 childhood cancer patients (age 1-21 years) were evaluated; 72 patients had a TIVAD in-situ and in 50 the TIVAD had been removed. Outcome parameters were hypertrophy (modified Vancouver Scar Scale (mVSS), scar surface area, pain, and itching. Scar abnormality was defined as mVSS of >2, or scar width >3mm. Results: Abnormal TIVAD scars were found in 107 participants. The mVSS score was higher in patients <= 45 months after removal and the widest >45 months after TIVAD removal. Multivariable analyses showed that the mVSS score was positively related with scar width (mm) and children being <= 45 months after TIVAD removal. Furthermore, TIVAD scar width was positively related with age at last TIVAD surgery, and associated with suture material. In conclusion, there was a high incidence of abnormal TIVAD scars with some pain and itching complaints. However, no typical cancer related influencing factors were associated with increasing abnormalities.