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Shoulder width reduction is done by removing a segment of bone from the medial or inner third of the clavicle. With bone removal in this location the incision is favorably placed in the supraclavicular fossa. Rather than placing the incision directly on the superior edge of the clavicle (a convex surface), it is placed superiorly to it in the supraclaviclar fossa which is a concave surface. With a concave surface the skin is thinner which is more favorable for less scar formation. It is also in a slightly more hidden location.

While the supraclavicular fossa skin may be thinner, it is also subject to a fair amount of traction on its edges. In performing the surgery through a small incision (3.5cm), it is necessary to stretch the skin around a fair amount particularly when applying the fixation plate. This does ‘beat up’ the skin edges so to speak which is not favorable for good scar formation.

As a result the healing of the skin incisions from clavicular reduction osteotomies will often become a little red and develop some slight hypertrophy in the short term. In the long term, however, these supraclavicular scars will fade to a a fine white line that is very acceptable aesthetically. But even in cases where the scar may not be as good as desired, a simple excisional scar revision would provide an excellent aesthetic outcome. Because in scar revision the stretching and trauma from the initial surgery is not necessary.

Dr. Barry Eppley

Indianapolis, Indiana

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