额颞部小切口多层次剥离除皱术

目的 探讨一种矫正额颞部老化征象简单而有效的方法。方法 采用额、颞部头皮发际内小切口、多层次(额部：骨膜下，额肌与皮肤间；颞部：颞浅筋膜眼轮匝肌与颞深筋膜间，颞浅筋膜眼轮匝肌与皮肤间)剥离，向上提紧额肌骨膜瓣和颞浅筋膜眼轮匝肌瓣，采用折叠缝合内固定(额部缝合固定于骨膜；颞部缝合固定于颞深筋膜表面)。不去除头皮，待其自然收缩恢复。结果 从2000年1月至2003年12月于临床应用20例，既获得满意的额颞部年轻化效果，又避免了冠状切口的并发症。结论 小切口多层次剥离是一种安全有效的额、颞部除皱术，既可单独应用于额部或颞部，也可额颞部同时进行手术。本方法具有时间短，损伤小，康复快，效果可靠等优点，同时避免冠状切口的并发症。     

额颞部小切口联合锯齿线悬吊除皱术

目的：为进一步改善小切口除皱术的效果,解决小切口除皱术后皮肤回缩再次下垂的不足。方法：基于传统的小切口除皱术,联合锯齿线悬吊术：先根据额颞部的皱纹情况进行小切口除皱手术,完成后再根据术前额部皱纹情况,进行锯齿线悬吊提紧额颞部皮肤术。结果：自2003年至2007年初,共施术59例,手术效果显著,额颞部皱纹去除明显,就医者满意度高。结论：额颞部小切口除皱术联合锯齿线悬吊的术后效果优于单纯的小切口除皱术和单纯的额颞部锯齿线悬吊术。     

小切口额眉提紧术联合重睑术治疗中重度上睑皮肤松垂症

目的探讨小切口额眉提紧术联合重睑术治疗中重度上睑皮肤松垂症的方法及疗效。方法采用小切口额部提紧术联合重睑术治疗中重度眼睑皮肤松垂症25例,通过发迹内或发迹缘小切口行帽状腱膜下剥离,眉毛及发迹缘行埋没导引缝合悬吊额眉部软组织,额眉组织提升后再行重睑成形术。结果本组切口平均0.9(0.8～1.0)cm,术后5～10d消肿,术后1月眼部形态恢复,额眉眼比例恢复。无一例大血肿、皮肤坏死等并发症。术后平均随访32个月(3个月～6年),所有患者上眼睑皮肤提紧,手术疤痕不明显。结论小切口额眉提紧术联合重睑术治疗中重度上睑皮肤松垂症简单、有效,不需特殊设备,在解除眼部症状的同时,又能达到良好的美容效果。     

改良限制性切口额颞部除皱术

目的 为提高额颞部除皱术的效果，延长有效时间，从理论与实际观察探讨额颞老年化改变形成的原因，并采用相应的手术术式进行矫正。方法 肿胀麻醉下，通过颞部发地缘切口入路，在颞深筋膜浅面剥离，内达颞肌前缘及眶外缘，下达颧弓上缘，后达耳屏前线。额部切口入路在悼状腱膜下剥离，下达眶上缘外至颞线后至枕外隆突。口腔内上颊龈沟入路在骨及颧弓骨膜下剥离。上述各剥离区域相互贯通，最后将颞区皮瓣上提，并将颞浅筋膜与颞深筋膜缝合固定。结果 本组共32例，术后眉外侧平均上提8mm，鼻唇沟变浅，获随访的7例为术后3－24个月，除皱效果满意。结论 本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊，同时减少上面部降肌的作用，相对增强提肌的作用，再辅以筋膜及皮肤上提固定达到除皱的目的，效果确实、可靠、安全、持久。     

额颞部除皱的同时行额肌帽状腱膜瓣折叠隆额术

目的：探讨额颞部除皱的同时行额肌帽状腱膜瓣折叠隆额术的新方法，评价其优缺点。方法：选额颞部皮肤老化、皱纹增多、伴有额头较扁平、要求同时行除皱及隆额的患者8例，采用冠状切口，在帽状腱膜下间隙剥离达眶上缘，在双侧额结节水平以上部位的头皮瓣下分离出额肌帽状腱膜瓣，将之折叠并垫于额结节水平以下部分，增加额部的高度；再将额颞部皮肤提紧，去除多余皮肤后缝合。结果：所有患者均随访6个月，术后效果均满意，未出现神经及毛囊损伤等并发症。结论：额颞部除皱的同时行额肌帽状腱膜瓣隆额术，不仅可以增强额颞部除皱的效果，还可有效地利用额部多余的自体额肌腱膜组织，无排异反应的发生，手术可以一次完成，效果满意。     

额颞部除皱术的方法改进

目的：探讨对轻、中度皮肤松驰患者选用改进的额颞部除皱术治疗的美容效果。方法：在额颞部小切口除皱术的基础上，将颞部切口延长至耳屏前，于颞部、颧部皮下充分分离，将眶部眼轮匝肌外缘向外上提升缝合固定于颞深筋膜层，同时将颧弓处颞浅筋膜也向外上方提升缝合固定于颞深筋膜层。结果：自2000年以来，采用此法治疗12例，术后随访1个月-2年，效果满意，无一例发生并发症。结论：此手术方法既消除了额纹、鱼尾纹，又减轻了鼻唇沟的深度，是一种疗效较好的除皱方法。     

改良限制性切口额颞部除皱术

目的　为提高额颞部除皱术的效果 ,延长有效时间 ,从理论与实际观察探讨额颞部老年化改变形成的原因 ,并采用相应的手术术式进行矫正。方法　肿胀麻醉下 ,通过颞部发际缘切口入路 ,在颞深筋膜浅面剥离 ,内达颞肌前缘及眶外缘 ,下达颧弓上缘 ,后达耳屏前线。额部切口入路在帽状腱膜下剥离 ,下达眶上缘外至颞线后至枕外隆突。口腔内上颊龈沟入路在颧骨及颧弓骨膜下剥离。上述各剥离区域相互贯通 ,最后将颞区皮瓣上提 ,并将颞浅筋膜与颞深筋膜缝合固定。结果　本组共 32例 ,术后眉外侧平均上提 8mm ,鼻唇沟变浅 ,获随访的 7例为术后 3～2 4个月 ,除皱效果满意。结论　本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊 ,同时减少上面部降肌的作用 ,相对增强提肌的作用 ,再辅以筋膜及皮肤上提固定达到除皱的目的 ,效果确实、可靠、安全、持久。     

额颞部微切口除皱术

目的　探讨额颞部微切口除皱术的临床效果及操作要点。方法　利用专用器械经微切口分别于帽状腱膜下层分离额顶部 ,SMAS筋膜浅层分离颞部 ;术中可酌情切断部分额肌、皱眉肌或降眉肌 ,祛除少量皮肤 ,折叠缝合颞部SMAS筋膜。术后用特殊的弹性绷带加压、牵拉固定。结果　本组 48例 ,其中 37例除皱效果明显 ,8例较术前改善 ,无效 3例。本组并发症有头皮局部血肿 2例 ,额部头皮点状坏死 1例。结论　额颞部微切口除皱术疗效肯定 ,具有手术时间短、损伤小、出血少、操作简便等优点 ,适合轻、中度额颞部皱纹者 ;术后确切的加压、牵拉固定是保证除皱效果的关键。     

额颞部微切口除皱术

目的　探讨额颞部微切口除皱术的临床效果及操作要点。方法　利用专用器械经微切口分别于帽状腱膜下层分离额顶部,SMAS筋膜浅层分离颞部;术中可酌情切断部分额肌、皱眉肌或降眉肌,祛除少量皮肤,折叠缝合颞部SMAS筋膜。术后用特殊的弹性绷带加压、牵拉固定。结果　本组48例,其中37例除皱效果明显,8例较术前改善,无效3例。本组并发症有头皮局部血肿2例,额部头皮点状坏死1例。结论　额颞部微切口除皱术疗效肯定,具有手术时间短、损伤小、出血少、操作简便等优点,适合轻、中度额颞部皱纹者;术后确切的加压、牵拉固定是保证除皱效果的关键。     

改良限制性切口额颞部除皱术

目的为提高额颞部除皱术的效果,延长有效时间,从理论与实际观察探讨额颞部老年化改变形成的原因,并采用相应的手术术式进行矫正.方法肿胀麻醉下,通过颞部发际缘切口入路,在颞深筋膜浅面剥离,内达颞肌前缘及眶外缘,下达颧弓上缘,后达耳屏前线.额部切口入路在帽状腱膜下剥离,下达眶上缘外至颞线后至枕外隆突.口腔内上颊龈沟入路在颧骨及颧弓骨膜下剥离.上述各剥离区域相互贯通,最后将颞区皮瓣上提,并将颞浅筋膜与颞深筋膜缝合固定.结果本组共32例,术后眉外侧平均上提8mm,鼻唇沟变浅,获随访的7例为术后3～24个月,除皱效果满意.结论本术式旨在通过广泛剥离解除了额颞部皮肤筋膜上提的羁绊,同时减少上面部降肌的作用,相对增强提肌的作用,再辅以筋膜及皮肤上提固定达到除皱的目的,效果确实、可靠、安全、持久.     

A Philosophy and Strategy for Surgical Hair Restoration: A 10-Year Experience

BACKGROUND: Three principal strategies have evolved for surgical hair restoration: follicular grafting, scalp reduction, and flap rotation. OBJECTIVE: Although grafting techniques have assumed a preeminent rank as the cornerstone of modern hair-replacement therapy, scalp reduction and rotation methods should not be entirely dismissed. METHODS: Over the past 10 years of clinical experience, the authors have relied on all three methods of hair restoration, carefully tailoring the optimal surgical approach to the patient's expressed concerns and particular regional hair deficit. RESULTS: We have found that scalp reduction and rotation provides a considerable density of hair unmatched by any grafting technique for the vertex and frontotemporal regions, respectively. CONCLUSION: Also we have concluded that the former yields the most natural result for a patient with significant crown baldness who desires hair restoration in that area. However, micro- and minigrafting still represent the overwhelming majority of our operative cases. This article attempts to review the surgical methodology and philosophy that have guided our approach to hair restoration.     

Chronic extensive necrotizing abscess of the scalp

Chronic subgaleal abscesses have been extremely rare since the advent of antimicrobial therapy. The majority of reported cases have occurred as acute infections following traumatic scalp lacerations or needle electrode insertion for fetal monitoring. The rich blood supply of the head makes widespread infection from a scalp surgical wound a very unlikely occurrence. Most acute infections of the scalp result in complete resolution with adequate early treatment. However, extensive purulent fibrosis of the scalp remains a potentially serious surgical complication. We report 2 cases of chronic necrotizing abscess of the scalp associated with a postsurgical scalp ulcer. The inflammatory process caused extensive necrotizing fibrosis (up to 2.5 cm thick) of the entire undersurface of the scalp and involved both the galea aponeurotica and the periosteum. We discuss the unique pathological features of this entity along with recommendations for its operative management and suggestions for flap design.     

骨膜带血管的自体骨改善股骨上段异体骨固定13例

目的：探讨骨膜带血管自体骨对促进异体骨固定的治疗。方法：回顾性分析总结了13例膜带血管自体骨促进异体骨固定的临床资料。结果：13例因人工关节翻修手术造成股骨上段骨缺损经骨膜带血管的自体骨促进异体骨固定的治疗，术后10例随访1－4．5年，效果满意。结论：股骨上段骨缺损的病例较少，但治疗困难。除应用定制的长柄假体外，采用异体骨移植同时应用骨膜带血管的自体骨促进其固定也不失为一种良策。     

胫骨骨折手术治疗后不愈合的原因及预防

目的 探讨胫骨骨折因手术治疗所致不愈合的原因分析及预防方法。方法 对589例胫骨骨折（包括胫腓骨骨折）手术治疗，加压钢板内固定320例，其它固定方法269例，包括外固定架100例；其中121例行骨膜旋转移植，87例行带蒂或带血管复合组织皮瓣移植，112例行腓骨截骨术，97例行植骨术。结果 589例胫骨骨折仅13例发生骨不愈合，6例为坚硬的加压钢板取出后原骨折处再次发生骨折。其余均达骨性愈合，随访平均24个月。结论 正确选择内外固定装置及安放位置，保护好邻近骨膜并作骨膜放旋转移植，必要时作腓骨截骨术，胫骨中下段骨折常规植骨，胫骨骨不愈合和再骨折发生率是可以预防的。     

微小切口导针埋线的额颞部除皱术

目的：避免传统面部除皱术所产生的头皮瘢痕，脱发，创伤较大，恢复时间长等不良反应。方法：对68例额颞部皮肤皱纹的求术者采用发际内微小切口入路，额颞部皮下潜行分离，将松垂的皮肤及筋膜上移，提紧，舒展皱纹，切除或切断形成皱纹的肌肉。其中单纯导针埋线颞部提紧除皱术11例，经微小切口入路颞部提紧除皱术25例。额颞部提紧除皱术32例。结果：随访6个月至2年，效果满意，头皮瘢痕不明显，无脱发等并发症。结论：导针埋线法额颞部除皱术，操作简单，可在门诊进行；创伤较轻，恢复较快，切口微小，瘢痕轻微。     

Nomenclature Proposal for the Zones and Landmarks of the Balding Scalp

BACKGROUND: Up until now there has existed no precise, agreed-upon terminology for referring to the areas of the balding scalp. OBJECTIVE: A standardized nomenclature system for the areas of the balding scalp is proposed so that physicians and other paraprofessionals can have a common, precise language for communicating with each other. METHODS: The following, in its initial form, was proposed to the surgical hair restoration community in the Hair Transplant Forum International in 1998. This final proposal includes feedback and input from those physicians. RESULTS: The balding scalp is divided into three major areas: the frontal region, the midscalp, and the vertex. Additional "subregions" are also defined, and long-standing landmarks of the scalp and its borders are reviewed. A new landmark, the "vertex transition point," is proposed, to designate that point in the posterior midscalp where the plane begins to change from horizontal to vertical. CONCLUSION: It is hoped that a universal nomenclature system for the scalp will facilitate communication between hair surgeons, other medical specialties, nonsurgical hair replacement personnel, and hair stylists.     

内窥镜骨膜下额部除皱骨固定19例

目的 探讨额部除皱术有效的固定方法及眉的彻底游离对内窥镜骨膜下额部除皱的影响。方法 行骨膜下剥离，尤其是眶周和和额-颞移行区充分分离；上提眉周组织并无张力固位；头皮经颅骨外板隧道固定.结果 本组19例均获得满意效果。其中1例曾并发右面神经额支麻痹，3个月后完全恢复.结论 经颅骨外板隧道的切口固定使术后眉位置保持良好，且除皱效果持久。     

Successful calvarial bone salvage using multiple outer table perforation technique on total scalp avulsion injury

For centuries, cranial outer table perforations were used to treat scalp avulsions that compromised the underlying periosteum. However, its use declined with the development of newer alternatives such as free-flap transpositions and scalp replantation. We report a case of extensive scalp avulsion with a large area of bone devoid of its periosteum. Outer calvarial plate perforations were drilled to promote granulation tissue growth. Skin grafts were used as a temporary coverage. The remaining scalp was then expanded, and the flaps obtained allowed a satisfactory coverage of the area of alopecia. The objective of this report is to bring this treatment method again into the set of possibilities to be considered when planning scalp reconstruction, as it is a feasible alternative and enables good results.     

带旋髂深血管髂骨--蝶形骨膜瓣复合移植治疗四肢骨不连

目的探讨四肢骨不连的治疗方法及疗效.方法 30例骨不连者采用髂骨-蝶形骨膜瓣复合移植结合坚强内、外固定.结果术后经1～2年随访,全部达到骨性愈合,其中1例股骨头坏死,1例股骨颈短缩愈合.临近关节功能恢复满意.结论带旋髂深血管髂骨-蝶形骨膜瓣复合移植治疗骨不连方法可靠,疗效肯定.     

Reconstruction of large defects in the scalp with fasciocutaneous flaps.

Although recent reports have emphasised free microsurgical transfer for reconstruction of extensive defects in the scalp, in our experience a carefully planned scalp flap is a simpler and safer method than a free transfer. Twenty-one patients with defects as large as 10%-60% of the scalp surface area were reconstructed; the calvarium was resected in five cases and the dura mater in two. In 18 cases the flaps were based on a single pedicle: the superficial temporal artery. In three cases the blood supply of the flaps was based on three major homolateral arteries: the superficial temporal, the posterior auricular, and the occipital. The blood supply of all scalp flaps was based on the interconnected network of the aponeurotic plexus and the pedicles were included into flap in 18 cases. The principles of fasciocutaneous flaps were applied for all 21 scalp flaps. The reconstruction of the skull was delayed in all cases, and the dura was replaced by free autogenous periosteum. The donor area was covered with a skin graft in all cases. In all patients the aesthetic and functional results were considered excellent by them and by us. There were no postoperative complications.