Open Heart Surgery Scars: Your Baby’s Surprise Warrior Wounds
When you think about open heart surgery scars you may quickly think of a scar running down the middle of the patient’s chest. Before my daughter was born, I knew she would need open heart surgery as a baby. Of course, I was more worried about her heart repair, but I was also anxious about the scars she would have to always live with. The world isn’t always kind.
I knew to expect the midline incision scar, however, I was surprised at the additional scars. She earned 8 scars in total from various wires and tubes. I didn’t know to anticipate these. Some babies may come away with fewer scars, while others could have even more. In this post, we’ll go over the different types of scars left behind from open heart surgery.
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Why do scars happen for heart surgery patients?
Scars can form wherever the skin has been broken and damaged. The body naturally produces new tissue at the site to heal it.
In open heart surgery, the surgeon needs to make a large cut in the chest in order to access the heart. Additionally, several different lines, wires, and tubes are used during the surgery and remain post-operatively for part of the recovery process. The cuts and access points of these can leave scars.
Everyone’s body is different and therefore everyone’s scars will be unique. A baby’s genes, health, skin type, age, surgery type, and use of various lines and wires will impact how their scars heal and look. How the skin is cut, where, how deeply, how long it’s open, infection, and treatment will also impact scar formation and prominence.
The Midline
The main scar you can anticipate from your baby’s open heart surgery is a scar running down the center of the chest. This is from the midline incision made during the sternotomy. This is where the surgeon cuts the skin and opens the sternum to access the heart.
As a baby, this line is typically long and stretches approximately 1/2 to 2/3 of their trunk. It can seem like the scar is taking over the whole baby. As they grow, the proportions may change.
There may be different marks depending on the method of closure the surgeon uses. The heart community often refers to this midline incision as a “zipper” scar.
Typically they use wires inside to hold the sternum together as it heals, these are not visible outside of the body. To close the skin, and aid the body’s healing process, a surgeon could use glue, stitches, or staples. As it heals, these will dissolve or be removed.
A newborn baby’s heart is approximately the size of a walnut. Yes, really, that small! Being able to properly and adequately access the heart is critical for surgeons to do their job. Meaning there is a good reason for this big scar.
Surprise open heart surgery scars
While the midline is often shown, discussed, and expected, there are several other scars from open heart surgery to anticipate. The following two surprised me, so I hope in explaining them here, more parents can be aware and prepared.
Sternum base scar
At the base of the sternum, in the middle of the bottom of the ribcage, your baby could have a prominent scar just below their midline incision. This scar, honestly, shocked me. It comes from the chest tube which is needed to allow excess blood to drain from around the heart post-op. The whole process around it felt antiquated.
My daughter has a single chest tube site scar only a little bit below her midline scar. They used the same site for both of her surgeries. It is fairly large and looks a bit rough compared to her clean straight midline incision.
Some people call their open heart surgery scar an exclamation point for this reason. They have a long straight line down their chest, punctuated by a large dot below it, just like an exclamation point. However, not all of them look this way. Depending on the child’s age, surgery, and specific case factors, they could have 1, 2, or even 3 chest tubes. Each separate chest tube will leave behind its own scar.
Belly scars
Slightly below the ribcage, top of the belly, on both sides your baby may have two different scars from their pacing wires. Despite their tiny size, these wires can leave their mark.
I did not know about these or anticipate any scars here. My daughter has two marks that each look slightly different below on either side of her chest tube scar.
Some babies have chest tube scars on their bellies if they had multiple chest tubes rather than a single one.
Hidden warrior wounds
Additionally, your child may have a few smaller and more discreet scars. Sometimes I forget my daughter even has these. If you know they’re there and looking, they’re noticeable. But relative to her others, physically these scars are minor.
Neck scar
The central line scar might look like a small dot, often for babies on their necks. This teeny catheter line is placed through a vein to the heart.
My daughter needed a central line for both her first and second surgeries. They inserted the wire in the same spot on her neck, so she has a single scar here.
Thigh scar
Another type of central line, a PICC, could be placed through a vein in the thigh for small babies. For older children, it could be inserted on the arm.
The PICC was the first thing my daughter needed. Even before her open heart surgery began, this line allowed them to get medicine to her heart as quickly as possible. She has a small scar dot on the inside of her thigh from the PICC.
Wrist scar
An arterial line can leave behind a thin line scar typically along the inside of the wrist.
This was one of the scars that surprised me the most. It’s relatively discreet, but still noticeable if you’re aware.
Hand or foot scar
Commonly heart babies need multiple IVs. These are often inserted in their hands or feet, or, for some newborns, even in their head or umbilical cord. While not everyone will develop a scar due to an IV, some babies might.
A different variation
For select heart defects (e.g., Coarctation of the Aorta) under a specific situation (not all qualify), a surgeon may be able to perform heart surgery via thoracotomy instead of via sternotomy. If this is the case for your child, their main scar will look different. Typically for babies having a thoracotomy, their scar is on their back at the base of their shoulder blade. It may wrap around their ribcage a bit.
Beyond the physical scars
I’d be remiss to mention there are scars beyond the physical ones. Emotional scars are just as real as physical ones.
For a child impacted by open heart surgery, they could develop anxiety, fears around medical settings, depression, or other psychological issues.
Parents can also be impacted by the trauma of watching their child go through this and may be triggered by the physical scars. Open heart surgery costs a family so much and can really take an emotional toll.
Scar awareness and understanding
Let’s start with a basic fact. Everyone has some type of scar somewhere on their body. Right now, I see 3 different scars on my hands and am always rubbing the one on my chin.
Scars are normal. Scars are common. Scars are pretty amazing, a sign of how incredible our bodies are. We don’t need to shy away from them.
Of course, some scars are far more significant than others, like scars from open heart surgery. However, that doesn’t mean they’re scary.
We aim to raise awareness of Congenital Heart Defects and scars are a part of this. Greater awareness can spark curiosity for more understanding. More understanding can lead to acceptance and appreciation.
Embracing and appreciating your warrior’s wounds
In the future, I hope people will not be taken aback by scars. Curiosity is okay, asking questions is how we all learn. However, there’s a difference between asking in a negative tone with judgment, letting fear lead, or even staring rudely. It’s possible to ask with respect and be curious in a positive way, or at least neutral not negative.
Don’t focus on the scars. Focus on what the scars represent. Open heart surgery scars tell an incredible story of bravery. Heart warriors go through so much – surviving heart surgery is no small feat. Their scars tell this story. Can we try to appreciate and even embrace them?
I’m not trying to make light of the fact that these marks are not the ideal beauty standard. Understandably those with CHD may have a very complicated relationship with their scars. While those of us who have not had open heart surgery cannot relate directly, we can listen to those who have, honor their journey, and respect their feelings around their scars. And hopefully, we can lift them up a little because they are incredible.
Let’s embrace our warriors’ wounds together. With a slight shift in perspective, we can focus on them as symbols of strength and survival. If we appreciate them, maybe our children will learn to wear their scars with pride and confidence. Some people choose to recognize them on National Zipper Day or National Scar Appreciation Day.
Closing
Walking your child through open heart surgery, recovery and always managing Congenital Heart Disease is not an easy journey. Your baby may wear more wounds internally and externally than you were anticipating.
No two CHDers marks will be exactly the same, they each have a unique heart, journey, and scars. They may have a midline incision or a scar around their back and side. Central lines, catheters, chest tubes, pacing wires, IVs, and arterial lines may leave additional lasting marks. Understanding and focusing on why these scars happen can guide us to appreciate the scars and the stories they tell.
