改良SMAS分离悬吊面中部除皱术

为了提高面中部除皱手术疗效和减少手术创伤，根据耳前部ＳＭＡＳ相对与下方组织紧密相加的解剖特点，将ＳＭＡＳ分为固定的和移动的两部分，提出于剥离移动ＳＭＡＳ后悬吊于固定的ＳＭＡＳ上的改良ＳＭＡＳ分离悬吊面中部除皱方法，以减少手术并发症，自１９９５年１至１１月经斯德拉斯堡欧洲美容整形诊所３１例的实践，均取得满意疗效。认为，移动的ＳＭＡＳ是应用ＳＭＡＳ悬吊除皱术的关键组织结构，固定的ＳＭＡＳ是手术设计必要     

改良SMAS分离悬吊面中部除皱术

为了提高面中部除皱手术疗效和减少手术创伤,根据耳前部SMAS相对与下方组织紧密相连的解剖特点,将SMAS分为固定的和移动的两部分,提出于剥离移动SMAS后悬吊于固定的SMAS上的改良SMAS分离悬吊面中部除皱方法,以减少手术并发症。自1995年1至11月经斯德拉斯堡欧洲美容整形诊所31例的实践,均取得满意疗效。认为,移动的SMAS是应用SMAS悬吊除皱术的关键组织结构,固定的SMAS是手术设计必要的组织基础。     

除皱手术的进展Ⅱ

除皱手术的进展Ⅱ吉林市职工医科大学附属医院（１３２０００）郑刚广西柳州美容城（５４５００５）李珑指导高景恒９０年代曾发表除皱手术的进展Ⅰ。该文综述了ＳＭＡＳ成形悬吊除皱术及相关解剖，是第二代除皱手术的发生、发展，及其理论基础。近年国内外在此领域内又有...     

鼻唇沟除皱术的局部解剖学与临床应用研究

目的提高鼻唇沟除皱手术效果。方法对１０例成人尸体２０侧鼻唇沟局部解剖及组织切片研究，发现鼻唇沟形成机理，改进手术方法。结果提出表情肌长期反复运动使得皮肤—皮下组织与ＳＭＡＳ—表情肌之间产生剪切应力及向下相对位移，鼻唇沟部位上下两种质地、结构密度相差较大的组织之间产生相对运动，形成了鼻唇沟及鼻唇沟脊。采用新手术方法为１３例患者进行鼻唇沟除皱手术，获得较好的近期及远期效果。结论鼻唇沟除皱手术须在ＳＭＡＳ表面、皮下组织深面正确层次中进行，切断ＳＭＡＳ与表情肌及上唇的联系，解剖复位颧颊部组织，重建颧弓韧带。     

改进的SMAS瓣悬吊除皱术

随着对面颈部解剖学的研究不断深入,面颈部除皱术从简单的皮肤提紧介入深层组织［１］,使除皱效果不断提高。作者自１９９６年９月～１９９８年６月,利用改进的ＳＭＡＳ瓣悬吊术结合颈部提紧术,提高了面中下部及颈部的除皱效果,报道如下。一、临床资料１６例施行面中...     

多层综合除皱术

应用多层综合的除皱方法使老化的面部年轻化。方法 进行多层次解剖分离，使老化移位的组织复位。包括皮肤及骨膜层的提紧，ＳＭＡＳ的悬吊，颧弓韧带的重建，颧骨的修薄。结果 自１９９３年以来，完成手术２８例，效果满意。结论面部老化是不同组织，不同解剖结构变化的综合体现。     

颞深部眶颧骨膜下除皱及SMAS剪力除皱术

笔者报告１９９３～１９９６年４６例面部除皱的经验，其中１２例颞深部眶颧骨膜下除皱（内含６例颧弓缩小整形），有或没有合并ＳＭＡＳ剪力除皱，３４例进行两个层次的除皱及剪力ＳＭＡＳ除皱。颞深部眶颧骨膜下除皱术采用颅面外科手术进路，在颞窝前方，眶周，外眦韧带区，部分眶内，颧弓周围及上颌骨前、外侧方分离骨膜，将其与帽状腱膜，颞浅筋膜及上半面部的皮肤、头皮同时提紧。有的病例同时进行颧弓缩小整形，术后使上半面部皮肤提紧，并使眼轮匝肌及其周围组织提紧，眉弓及眼角上悬，上、下眼睑松弛矫正，眼鼻沟，鼻唇沟变浅。特别对中年以上的上２／３面部除皱有效。ＳＭＡＳ剪力除皱是下半面部除皱。将皮肤及ＳＭＡＳ两平面进行提紧，耳前制成Ｓ状ＳＭＡＳ瓣，在其中央剪成两半，向上及向耳后方提紧，使颊、下颌、颈部松弛组织提紧，鼻唇沟变浅。颏下区松坠的脂肪作抽吸或切除。     

改良骨膜下综合剥防除皱术100例分析

目的 为了更有效地使面中部老化组织向上提紧复位。方法 采用扩大的面部骨膜下剥离，或加用ＳＭＡＳ下和皮下多层次综合剥离除皱术。尤其在颧弓部骨膜下进行剥离松解，掀起颧弓韧带的起点，以解除面中部老化组织上提复位的屏障。结果 本组１００例术后显示恢复面部各层组织年轻时的解剖关系，获得了年轻时鼻唇沟的形态和颌线轮廓，效果满意。未出现面神经额支受牵拉损伤的征象。结论 本法适用于不同年龄，尤其是４０岁左右的除皱     

多层综合除皱术

目的应用多层综合的除皱方法使老化的面部年轻化。方法进行多层次解剖分离，使老化移位的组织复位。包括皮肤及骨膜层的提紧，ＳＭＡＳ的悬吊，颧弓韧带的重建，颧骨的修薄。结果自１９９３年以来，完成手术２８例，效果满意。结论面部老化是不同组织，不同解剖结构变化的综合体现。单一层次的除皱方法不能取得全面的年轻化效果，多层综合的除皱方法恢复了年轻的解剖生理关系，使因老化导致的面部软组织的松弛移位得到充分的矫正，具有全面的年轻化效果     

面中部双层皮肤软组织提紧术

目的：为了改善面中部皮肤、软组织松驰，方法：通过分离面中部皮下组织和颧弓韧带组织，将颧部软组织向外上方复位并固定于颧骨骨膜上。结果：通过手术可有效地恢复中部松驰下垂的组织平化了鼻唇沟的深度。结论：应用面中部双层皮肤软组织是紧术，通过双层提紧固定，可以达到永久悬吊的作用。     

两级递进式提紧浅表肌腱膜系统除皱术

目的探讨两级递进式提紧面部浅表肌腱膜系统（superficial muscular aponeurotic system，SMAS）-颈阔肌除皱术效果。方法颞面颈部皮下小范围分离，颞区颞深筋膜浅面大范围分离，面颈部SMAS-颈阔肌下大范围分离，离断SMAS-颧颊部韧带。分SMAS-颈阔肌瓣为前、后两叶。先提紧前叶：在其前下方最远处以3-0涤纶线横褥式缝1针向后上提紧固定在SMAS的后上切缘处；再在其后上方以褥式缝合固定在颧弓根部骨膜上。后提紧后叶：在其前下方最远处以3-0涤纶线横褥式缝合，向后提紧固定在SMAS瓣的后切缘处；再在其后方横褥式缝合固定在胸锁乳突肌腱膜上。颞支蒂瓣也以两级递进式提紧固定，重建颈阔肌-耳韧带。额部除皱术的操作要点是确切地切除皱眉肌、降眉肌和额肌。结果共施术284例，绝大部分结果令医者与受术者双方满意。仅有9例发生中度（15～20ml）血肿，8例耳后乳突区皮瓣早期血运不良，经及时处理无不良后果产生。结论两级递进式提紧固定SMAS-颈阔肌瓣和颞支蒂瓣，对于提紧表情区，特别是鼻唇沟附近、颌缘前段的软组织松垂，具有比较明显的效果，但是对于静态脸型或（和）动态脸型比较宽大者，上述方法的效果不明显。     

Face lift,part 4: Use of superficial musculoaponeurotic system suspending sutures

We describe nonabsorbable sutures running from one or more sites in the superficial musculoaponeurotic system (SMAS), to other sites at a distance, or to fixed sites beyond or deep to SMAS for the purpose of pulling on or suspending the distal selected SMAS sites or changing contours between the suture ends. Our reasons for abandoning some sutures and continuing with others are stated. In face lifting, we still often employ sutures running from the anterior part of the platysma and SMAS back to the sternocleidomastoid fascia. These sutures help prevent platysma “cording” and are useful in the restoration and preservation of a more youthful profile in the neck. Examples and controls are demonstrated. These sutures and the long-term results of their use have never been shown before. Problems encountered in using suspending sutures are described.     

The oriental aging face: An evaluation of a decade of experience with the triangular SMAS flap technique in facelifting

The triangular SMAS flap technique was developed through a thorough understanding of the morphological and anatomical problems of the aging Oriental face. A unique manipulation of two triangular SMAS flaps—TSF-1 and TSF-2—permits three-directional lifting of the SMAS, which provides supportive and distributive lifting while reducing unwanted tension in the skin. TSF-1 is the excess portion of the main SMAS flap which results from cephalic lifting in the zygomatic area. TSF-2 is created from the excess portion produced by posterior advancement in the preauricular area, and is rotated to the postauricular area. Use of the TSF-1 flap involves complete excision, folding under, or free grafting. The retroauricular TSF-2 flap indirectly achieves platysmal plication. The author evaluates ten years of experience with the triangular SMAS flap technique and describes the entire aspect of the aging face in Orientals.The triangular SMAS flap technique was first presented at the 6th Congress of the International Society of Aesthetic Plastic Surgery, Tokyo, Japan, September 28–October 2, 1981     

Lateral SMASectomy, plication and short scar facelifts: indications and techniques

This article discusses removing a portion of the superficial musculoaponeurotic system (SMAS) in the region directly overlying the anterior edge of the parotid gland, called a lateral SMASectomy. Excision of the superficial fascia in this region secures mobile anterior SMAS to the fixed portion of the superficial fascia overlying the parotid. It is a rapid, safe, and reproducible operation, providing the versatility of traditional SMAS flap undermining and the safety and rapidity of SMAS plication in carefully selected patients.     

A Stratigraphic Approach to the Superficial Musculoaponeurotic System and Its Anatomic Correlation with the Superficial Fascia

The superficial musculoaponeurotic system (SMAS) is not included in the International Anatomic Terminology, although it is a fundamental anatomical structure in plastic surgeons. In the literature, the concept of the SMAS is not clear, leading to repercussions in the treatment of the SMAS via the various techniques for rhytidoplasty. This review article, in its aim to conceptualize the SMAS, has as a referential parameter the basic stratigraphic pattern of the human body construction. A systematic review of the literature was performed through Medline, ISI-Web of Science, and Lilacs databases as well as through classical treatises of anatomy for analyses of the stratigraphic principle of SMAS and its relationship to the fascia. In fact, SMAS, an anatomic entity, is part of this construction model. The stratigraphic approach followed in this article to describe the SMAS is novel in the literature and allows for a unified anatomic understanding of SMAS for the scientific community.     

Superior mesenteric artery (Wilkie’s) syndrome: a rare cause of upper gastrointestinal system obstruction

Background Superior mesenteric artery syndrome (SMAS) results from the compression of the third part of the duodenum between the aorta and the proximal part of the superior mesenteric artery (SMA). Clinical presentation of SMAS is characterized by the dilatation of the proximal part of the third part of the duodenum. SMAS is a rare cause of the upper gastrointestinal system (UGS) obstruction. In this study, we aimed to present our clinical experience in the treatment of five patients with SMAS, which is a rare clinical condition requiring surgery.

Patients and methods The retrospective study included five patients who were treated due to SMAS at our clinic between January 2010 and January 2014.

Results All the patients were underweight, with a mean BMI of 15.73 (14–16). The clinical symptoms included epigastric pain after food intake, large volume bilious emesis, early satiety, failure to gain weight, indigestion, esophageal reflux, sense of fullness, and persistent weight loss. SMAS was diagnosed using barium meal studies, upper gastrointestinal endoscopy, abdominal ultrasonography, and CT angiography. Four patients underwent duodenojejunostomy and one patient was managed with gastrojejunostomy. No complication was observed during the postoperative period, and all the patients achieved significant improvement in symptoms.

Conclusion SMAS is a rare cause of UGS obstruction, and the diagnosis of SMAS is often delayed. SMAS should be suspected in the differential diagnosis of the patients with unsubstantiated symptoms of persistent nausea, emesis, and significant weight loss.     

颞部及耳前SMAS蒂皮瓣在眼周皮肤缺损修复中的应用

目的：探讨颞部及耳前表浅肌肉筋膜（SMAS）蒂皮瓣在眼周皮肤软组织缺损修复中的应用。方法：根据眼周缺损皮肤形状及面积大小沿同侧颞部及耳前设计以SMAS为蒂的皮瓣,用于眼周皮肤软组织缺损的修复,最大皮瓣8.5cm×4.3cm。结果：8例眼周皮肤缺损病人应用同侧SMAS蒂皮瓣修复创面,术后皮瓣全部成活,经6个月～2年随访,发现皮瓣与周围皮肤组织在色泽、质地、轮廓等方面较匹配,切口瘢痕平软而且较隐蔽。面部的轮廓及视觉效果良好,其形态及美学效果均满意。结论：颞部、耳前SMAS蒂皮瓣在设计上遵循了面部分区原则,而且血供丰富,手术简单易行,是较大面积眼周皮肤缺损创面修复的理想选择。     

颈阔肌肌瓣在面颈部除皱术中的应用

目的为解决颏颈部老化提供一种新的更有效的方法。方法采用多层次除皱法，耳前分离一舌形SMAS筋膜瓣转移至耳后，缝合固定于乳突区筋膜表面，颈阔肌采用T形瓣法，将两瓣向后上方悬吊固定于乳突区，修剪多余的皮肤。结果临床应用12例，随访6个月至1年，术后效果均满意，无一例出现面神经损伤及术后并发症。结论在面颈部除皱术中，采用改良的SMAS筋膜瓣法加强下颌缘上提作用的同时结合颈阔肌肌瓣悬吊法，使颈部除皱效果大大改善，亦增强了面部除皱术的效果。     

Superior mesenteric artery syndrome: a rare cause of complete intestinal obstruction in neonates

Superior mesenteric artery syndrome (SMAS) is an uncommon cause of high intestinal obstruction in neonates; it is owing to incomplete obstruction in the third part of the duodenum caused by compression between the SMA and abdominal aorta. In neonates, complete intestinal obstruction owing to SMAS has been very rarely reported in the literature .We present a 7-day-old previously healthy male infant with a short history of gastroenteritis and sepsis followed by progressive abdominal distension and persistent bilious vomiting that resulted in hypovolemic shock. The patient was aggressively resuscitated, and a gastrografin study showed a hugely distended stomach with an abrupt narrowing at the third part of the duodenum. Exploratory laparotomy unexpectedly revealed a high insertion of the duodenum at the ligament of Treitz, with upward displacement and SMA compression leading to duodenal obstruction. The ligament of Treitz was divided, and the duodenum, mobilized. The postoperative course was uneventful. Although extremely rare, SMAS should be considered as one of the differential diagnoses in newborns presenting with complete intestinal obstruction, especially if preceded by gastroenteritis or sepsis-like symptoms.