长脉冲Nd：YAG l064nm激光对耳后皮肤扩张期间的脱毛效果观察

目的：观察激光对耳后皮肤扩张期间的脱毛疗效。方法：应用长脉冲可调脉宽Nd：YAG 1064nm激光治疗仪进行治疗。术中从低能量开始,至毛发从毛孔溢出,毛囊焦化为止,在耳后乳突区皮肤扩张过程中进行脱毛治疗。结果：32例脱毛患者均取得了理想的效果,一般1～2个月可有部分毛发再生,但毛发细小、色淡,需再次治疗2～3次,即可完全达到脱毛的目的。结论：长脉冲Nd：YAG 1064nm激光进行扩张期脱毛是安全的,较耳廓再造术后脱毛效果更明显,更容易祛除转移的扩张皮肤上的毛发,特别是耳后隐窝内的毛发更容易处理,使得激光操作简单。     

扩张颞浅岛状皮瓣联合激光脱毛治疗面颈部瘢痕的护理

目的 探讨扩张颞浅岛状皮瓣联合激光脱毛治疗面颈部瘢痕患者的护理方法。方法 2015年1月至2018年12月,我们采用扩张颞浅岛状皮瓣联合激光脱毛治疗面颈部瘢痕患者10例,期间给予心理护理、皮肤护理、体位护理、创面护理及激光治疗的护理。结果 本组仅1例出现术后血运障碍,属静脉回流障碍,经48 h间断针刺放血后皮瓣血运逐渐稳定;其余患者皮瓣成活良好,创面Ⅰ期愈合。术后随访1年,10例皮瓣均完全存活,面颈部外形良好,功能改善。结论 扩张颞浅岛状皮瓣联合激光脱毛治疗面颈部瘢痕,及时有效的围手术期护理和激光脱毛治疗期护理可有效减少并发症的产生。     

额部扩张皮瓣半鼻再造术

目的：介绍应用额部扩张皮瓣进行半鼻再造的体会。方法：总结9例采用扩张后的额部皮瓣转移后作为再造鼻的皮肤覆盖,局部翻转皮瓣作为鼻腔衬里,移植肋软骨或耳甲软骨重建鼻支持组织的手术方法。结果：9例中8例获得满意效果,再造半鼻与健侧基本对称。1例额部扩张皮瓣远端淤血坏死。结论：应用额部扩张皮瓣进行半鼻再造是可行的。     

Medpor外耳再造术皮肤覆盖方案的临床研究

目的:本文通过比较几种不同的支架外皮肤覆盖方案,探索一种手术效果稳定可靠的合成材料支架外耳再造方法。方法:48例先天性小耳畸形,应用Medpor支架行全外耳再造术,支架外软组织覆盖材料分别为单纯乳突区扩张皮肤1例、颞顶筋膜瓣加植皮25例、乳突区扩张皮瓣加颞顶筋膜瓣22例,观察比较应用不同覆盖材料耳再造后支架外露发生率、再造外耳外形轮廓、表面皮肤颜色质地。结果:临床应用48例,随访1至6年,应用单纯乳突区扩张皮瓣覆盖者1年内耳支架完全外露;应用颞顶筋膜瓣加植皮者再造耳廓外形及轮廓优良,但大部分病例再造耳廓皮瓣不同程度色素异常;应用乳突区扩张皮瓣及颞顶筋膜瓣联合覆盖者再造外耳形态及轮廓均优良,且表面皮瓣颜色质地与周围皮肤和对侧外耳皮肤一致,美容效果最佳。结论:应用乳突区扩张后皮瓣及颞顶筋膜瓣双层组织瓣的软组织覆盖方案可以满足Medpor再造外耳的外形、轮廓及皮色的需求,是一项安全稳定的手术方案,综合效果优于颞顶筋膜瓣加植皮方案,而单纯应用乳突区扩张皮瓣的方案不适用于Medpor外耳再造术。因此推荐在选用Medpor耳支架行全外耳再造治疗Ⅲ度先天性小耳畸形时,优先选用颞顶筋膜瓣联合乳突区扩张皮瓣的软组织覆盖方案。     

光子脱毛结合点阵激光治疗额部扩张皮瓣鼻再造术后多毛患者一例

额部扩张皮瓣转移行鼻再造现已多运用于临床,而术后皮瓣多毛及色素沉着常影响患者生活,故激光治疗势在必行。本文报道1例鼻再造术后患者经光子脱毛及点阵激光联合治疗后取得的良好效果,为以后皮瓣患者进行激光治疗提供经验。     

扩张颞浅血管蒂头部皮瓣移植联合激光脱毛修复面部皮肤缺损

目的 探讨扩张颞浅血管蒂头部皮瓣移植联合激光脱毛修复面部皮肤缺损的临床效果.方法 2010年1月至2011年12月,对6例面部大面积瘢痕患者,应用扩张颢浅血管蒂头部皮瓣移植联合激光脱毛治疗.治疗过程分三期进行.一期:根据面部瘢痕的大小和形状在同侧头部放置皮肤扩张器,术后定期注水扩张.二期:待扩张头皮组织量达到要求后,取出扩张器,形成颞浅血管蒂的头部皮瓣,移植修复面部皮肤缺损.三期:二期术后2周,开始对移植皮瓣进行激光脱毛,一般4～6次治疗后皮瓣毛发消脱干净.结果 6例7块皮瓣完全覆盖面部皮肤缺损,血供良好,全部存活,供区皮肤直接拉拢缝合;激光脱毛效果肯定.经术后6个月至1年随访,皮瓣与周围皮肤组织在色泽、质地、厚度等方面较匹配,面部轮廓、形态及美学效果均满意.结论 扩张颞浅血管蒂头部皮瓣移植联合激光脱毛是修复面部大面积皮肤缺损的较好方法.     

耳廓再造术中扩张皮瓣破溃感染的预防和处理

目的：观察在利用扩张皮瓣结合肋软骨雕刻耳支架移植进行耳廓再造过程中发生扩张皮瓣破溃感染时耳廓再造的治疗。方法：58例先天性小耳畸形患者,于耳后皮瓣扩张过程中发生了扩张皮瓣破溃、感染等并发症,根据不同情况,28例行即刻耳廓再造术,15例行扩张皮瓣舒平,延期耳廓再造术,12例行扩张器取出的延期重新扩张的耳廓再造术,3例经抗感染治疗,继续扩张过程。结果：58例患者术后再造耳效果良好。结论：在利用皮肤扩张法进行耳再造术时,即使发生了扩张皮瓣破溃、感染等并发症,经适当的积极治疗,可望获得良好的效果。     

额部扩张皮瓣法半鼻再造术修复部分鼻缺损

目的：探讨应用扩张额部皮瓣行半鼻再造术修复部分鼻缺损的效果。方法：2008年6月～2010年12月,收治部分鼻缺损患者5例,男1例,女4例,均采用额部扩张皮瓣法半鼻再造术修复。手术分3期进行：Ⅰ期行额部额肌下扩张器置入术皮肤扩张;Ⅱ期行额部扩张皮瓣转移半鼻再造术;Ⅲ期行鼻根部皮瓣断蒂修整术。结果：术后患者均愈合良好,无明显并发症发生。5例患者均获随访,随访时间6月～1年。再造鼻形态满意,颜色、质地与周围皮肤较为匹配,额部供区无明显瘢痕及畸形。结论：额部扩张皮瓣法行半鼻再造术修复鼻缺损,手术方法简单可靠,术后效果满意。     

颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架外耳再造术

目的探讨颞顶筋膜瓣与扩张皮瓣联合覆盖Medpor支架再造外耳的效果。方法手术分两期进行:一期手术在乳突区置入皮肤软组织扩张器,并定时注水扩张;第二期手术将扩张器取出并形成蒂在前的扩张皮瓣、掀起以颞浅血管为蒂的颞顶筋膜瓣,应用颞顶筋膜瓣和乳突区扩张皮瓣双重由里至外覆盖Medpor耳支架完成耳廓再造。结果临床应用22例,随访半年至2年半,无耳支架外露发生,再造的耳廓外形逼真,轮廓分明,肤色与周围正常皮肤一致。结论应用乳突区扩张皮瓣及颞顶筋膜瓣双层组织瓣包被Medpor耳支架,可以提高Medpor耳支架置入的安全性,避免发生外露,又不影响支架外形和轮廓的显现,再造耳表面皮肤的色泽与周围皮肤一致。     

激光脱毛在头皮扩张穿支皮瓣制备过程中的应用

目的 探讨在头皮扩张皮瓣的扩张期进行激光脱毛的安全性及疗效。方法 2014年1月到2015年4月,选择22例应用头皮扩张穿支皮瓣修复面部软组织缺损的患者,在注水扩张期使用半导体激光进行脱毛治疗。结果 22例患者均完成了扩张器置入-注水扩张-激光脱毛-转移修复的序贯疗程。转移修复术后皮瓣均存活,19例皮瓣表面无明显粗长毛发,2例皮瓣仍有少量毛发残留,1例发际边缘小面积秃发。1例患者在激光治疗后出现水疱,1周后自愈,未观察到长期并发症。结论 激光脱毛技术可安全有效地应用于头皮扩张穿支皮瓣的制备过程,改善皮瓣修复术后患者面部外观,提高手术满意率。     

A review of the adverse effects of laser hair removal

Laser hair removal is ever increasing in popularity. Technology is fast advancing, and there are increasingly excessive commercial claims that laser hair removal in all skin types is free of side effects. The aim of this study is to review the evidence from published literature regarding the incidence of adverse effects after laser and light systems for hair removal. A review of the current published literature on the ill effects reported after laser/light-assisted depilation was conducted. Overall incidence of adverse effects after laser/light hair removal appears to be low, with very uncommon permanent sequelae. The two largest studies to date have shown that acute and transient side effects do occur. Higher incidence of pigmentary alterations is associated with the shorter wavelength lasers (up to 19%), particularly with darker skin types, compared with lower incidence using the neodymium–yttrium–aluminium–garnet laser (2–3%). Both studies did not show any long-term side effects or scarring. Laser/light hair removal, carried out by trained professionals, is a safe procedure with a very low incidence of permanent sequelae. The majority of adverse effects are transient and minor. They are more common in darker skin. Longer wavelength devices reduce the risk in darker skin.     

The temperatures reached and the damage caused to hair follicles by the normal-mode ruby laser when used for depilation

Although it is proposed that heat is the cause of follicular damage leading to depilation, this has never been proved. This study aims to determine the mode by which depilation is effected and, if heat is the mechanism, what temperatures are reached within treated follicles and if sufficient damage is produced therein. Two excised specimens of hair-bearing skin from 5 patients undergoing facelifts were dissected to reveal the hair bulbs/shafts on the deep surface. They were placed on a jig, and one pulse from a normal-mode ruby laser (NMRL) of 15 J per square centimeter was fired on the epidermal surface. A thermal imaging camera recorded dermal temperature changes on the deep surface in real time. Specimens were then examined histologically for the site and extent of cellular damage by immunohistochemical staining for a protein marker of cell damage (p53). The NMRL targeted hair follicles specifically. The most common follicular temperature increase ranged from 5 to 10 degrees C. In specimens from 1 patient the increase was more than 30 degrees C (p < 0.001). Heat dissipation into interfollicular tissue in all specimens occurred 2 seconds after exposure. Evidence of laser-induced damage to follicle-lining cells was found only in those follicles with damaged hair shafts. The changes were found to a greater depth (to the bulb) and greater extent (beyond the bulge) in those follicles reaching higher temperatures. These findings suggest that the NMRL should produce permanent depilation. The variability between follicles and between patients explains, perhaps, the uneven outcome regarding depilation using the NMRL. Success appears to depend on peak follicular temperatures achieved during laser exposure, which may result from the follicular characteristics of the individual patient.     

Successful reduction in skin damage resulting from exposure to the normal-mode ruby laser in an animal model.

Normal-mode ruby laser (NMRL) irradiation of skin has now become an acceptable method of producing depilation. However, side effects, which include superficial burning and changes in skin pigmentation, still occur and, although temporary, can be distressing to the patient. This paper reports a method by which the skin can be protected (or preconditioned) from damage during NMRL treatment by pre-heating to a lower, non-damaging level prior to irradiation. Using the black-haired mouse (C57B1/10) as an animal model, an appropriate 'preconditioning' temperature was established by exposing the mouse skin to a range of temperatures, taking biopsies and staining the skin immunohistochemically for heat shock protein 70 (HSP 70) expression within the keratinocyte cells. Increased HSP 70 expression is stimulated by exposure to environmental stressors such as heat, so it was hypothesised that its increased expression conveyed increased cellular protection. The appropriate temperature (45 degrees C for 15 min) allowed for the superficial skin cells to be protected (as assessed by maximal HSP 70 staining) but undamaged (as assessed by haematoxylin and eosin staining), leaving the target hair-producing cells unprotected. Eight mice (16 flanks) were then exposed to this preconditioning temperature (eight of the flanks being growing-hair sites and eight resting-hair sites) and 5 h later exposed to a laser fluence known to cause mild skin damage and depilation (6J/cm2). This exposure was to both the preconditioned and the adjacent non-preconditioned sites. A statistically significant reduction in skin damage (P <0.001), as measured by the time taken to heal and noted both clinically and histologically, was seen in the preconditioned sites in resting-hair regions but not in growing-hair regions. Depilation, established over an 8 week period, was successful in growing-hair regions within both preconditioned and non-preconditioned sites, but complete hair regrowth had occurred in preconditioned and non-preconditioned sites within resting-hair regions by 5 weeks. The latter finding was consistent with work already reported suggesting that NMRL-assisted depilation in this animal model is not successful for hairs in the telogen phase. Successful preconditioning of mouse skin prior to laser exposure appears to reduce NMRL-induced skin side effects. In addition, the technique does not appear to adversely affect successful depilation.     

Laser depilation of the natal cleft--an aid to healing the pilonidal sinus

BACKGROUND: Pilonidal disease is common. Excessive hair growth in the natal cleft is thought to be a factor in initiating these sinuses. It is chronic and intermittent in nature and treatment can be difficult. Hair removal by shaving or use of creams is often advised as a compliment to surgical treatments. However, access to the natal cleft can be difficult. Laser removal of hair in the natal cleft is considered as an aid to healing the pilonidal sinus. PATIENTS AND METHODS: Over a 5-year period, 14 patients with recurrent pilonidal disease were treated in our unit with laser depilation. They were all contacted by postal questionnaire, and those with ongoing disease were asked to return to the clinic for evaluation and possible further treatment. RESULTS: All patients returned the postal questionnaire. Of the 14 patients, 4 had on-going disease and received further depilation with the Alexandrite laser. All are now healed with no reported complications. All patients found the procedure painful and received local anaesthetic. CONCLUSIONS: Laser depilation in the natal cleft is by no means a cure for pilonidal disease. Removal of hair by this method represents an alternative and effective method of hair removal and, although long lasting, is only temporary. However, it allows the sinuses to heal rapidly. It is relatively safe, and simple to teach, with few complications. It should thus be considered as an aid to healing the problem pilonidal sinus.     

光子脱毛联合较大体积扩张器法行外耳再造的临床研究

目的探讨采用光子脱毛联合较大体积扩张器法行外耳再造术治疗小耳畸形的临床效果。方法2000年1月～2006年1月，收治先天性单侧小耳畸形患者73例。32例采用光子脱毛联合较大体积扩张器扩张方法（新方法组）。其中男12例，女20例；年龄6～45岁。小耳畸形I度6例，Ⅱ度20例，Ⅲ度6例。切取皮瓣范围9cm×5cm～11cm×6cm，筋膜瓣范围7cm×5cm～9cm×6cm。余41例采用常规扩张法进行外耳再造（传统组）。其中男13例，女28例；年龄6～42岁。小耳畸形I度8例，Ⅱ度27例，Ⅲ度6例。切取皮瓣范围8cm×5cm～10cm×6cm，筋膜瓣范围7cm×5cm～9cm×6cm。对两组术中切取皮肤、术后供区瘢痕面积进行测定，比较患者及家属满意率及并发症发生率。结果患者均在二期术后6～12个月行三期再造耳修整时随访。新方法组：术后皮瓣及移植皮片均成活，切口I期愈合；再造耳耳轮脚及耳轮清晰，耳轮缘无毛发生长。传统组：1例术后皮瓣远端部分坏死导致支架外露，经对症处理后愈合；余患者皮瓣及移植皮片均成活，切口1期愈合；再造耳耳轮清晰，耳甲及耳舟可见，35例再造耳廓耳轮上部边缘有部分毛发。新方法组切取皮肤、瘢痕面积及患者满意率分别为18．3±1．5cm。、8．1±0．8cm^2及86％，与传统组（34．2±2．6cm^2、14．4±1．2cm^2及71％）比较，差异有统计学意义（P〈0．05）。新方法组并发症的发生率为3．1％，与传统组4．6％比较，差异无统计学意义（P〉0．05）。结论光子脱毛联合较大体积扩张器法行外耳再造在未增加并发症的基础上，实现较大体积的皮肤扩张，二期再造时切取的皮肤面积小，术后瘢痕轻，再造耳无毛发，外观佳。     

Hair removal by long-pulse alexandrite laser in oriental patients

The laser depilation system, cleared by the Food and Drug Administration since 1995, is evolving rapidly. However, the parameters in the hair removal function of these devices emphasize use for white people with fair skin (Fitzpatrick types I, II, or III). The characteristics of oriental skin and hair are black, coarse hairs in darker skin (Fitzpatrick types IV or V). As seen, the higher the skin melanin content, the more difficult to remove hair by laser. The authors report 146 oriental patients (156 body sites) who underwent treatment with the long-pulse alexandrite laser (wavelength, 755 nm) depilation system since November 1997. Percentage of hair removal (clearance rate) was assessed, and the histological change from laser pulse damage was observed. After two treatments, the clearance rates in the axillae and the leg were 61% and 62% respectively in the 15 to 20-J group (N = 47), and were 66% and 67% respectively in 21 to 25-J group (N = 64). After five treatments, 59 patients (37 axillae and 22 legs, all of which received 21-25 J per square centimeter of laser energy treatment during the course) had an average clearance rate of 91% (axillae) and 86% (leg), and the clearance rates have been maintained near 90% after long-term follow-up (average follow-up, 17 months). Minimal and transient complications are noted. In conclusion, using a combination of longer wavelength (but still in the optimal window of 630-870 nm), long pulse duration (10-40 msec), high fluence (but limited up to 25 J per square centimeter), multiple treatments, and concomitant direct cooling applied to the skin of oriental patients (Fitzpatrick types IV and V) with black, moderately coarse hair shafts achieves satisfying long-term hair removal results.     

Nd:YAG Laser Treatment of Recalcitrant Folliculitis Decalvans

BACKGROUND: The scarring follicular disorders pose challenging therapeutic dilemmas. OBJECTIVE: Hair removal lasers have recently been shown to be efficacious in the management of these disorders. METHODS: We present a young, Fitzpatrick skin type VI African-American patient with recalcitrant folliculitis decalvans, whom we treated with the neodymium:yttrium aluminum garnet (Nd:YAG) laser. RESULTS: A remission of folliculitis decalvans was successfully achieved using the Nd:YAG for laser depilation. CONCLUSION: Based on the optical properties of light in skin, the Nd:YAG laser is the best for laser depilation in dark individuals.     

Platysma skin flap: Laryngeal repair material to produce phonatory flap vibrational wave

The platysma skin flap was used for laryngeal reconstruction after vertical partial laryngectomy to improve the postoperative voice quality of patients with T2 and T3 glottic laryngeal carcinoma. Sixty‐nine patients with unilateral T2 and T3 glottic laryngeal carcinoma were included. Forty‐six patients received vertical partial laryngectomy, and a platysma skin flap was used for laryngeal reconstruction. The other 23 patients underwent transoral laser microsurgery. Subjective and objective examinations were performed to evaluate laryngeal morphology after the surgery. Acceptable voice quality was achieved for 46 patients who underwent vertical partial laryngectomy. Flap vibrational waves occurred in 19 cases (41.3%). The platysma skin flap is an ideal tissue for the reconstruction of articulation structure in open surgery of T2 and T3 unilateral glottic laryngeal carcinoma.     

手术去毛法在低发际小耳畸形者耳廓再造中的应用

目的：探讨低发际者以手术去毛后的皮肤再造耳廓的方法。方法：对于发际特低型小耳畸形患者，以手术去毛洗去除其耳后带毛皮肤的部分毛囊和真皮，使之形成皮片后回植。半年后再扩张此区皮肤，以扩张皮瓣覆盖耳支架的方法再造耳廓。对于发际稍低型小耳畸形患者，经扩张耳后带毛皮肤后以手术去毛发去除部分毛囊，然后再造耳廓。结果：经手术去毛发后的皮肤扩张过程顺利，再造耳廓外形良好，皮肤上仅再生出很少短细的浅色毛发。结论：在低发际小耳畸型的耳廓再造中，手术去毛法是有效可行的方法。