埋没导引缝合法修复下睑皮肤软组织部分缺损

目的探讨埋没导引缝合法修复下睑皮肤软组织轻中度缺损的疗效。方法应用埋没导引缝合法将下睑眼轮匝肌肌皮瓣及部分眶肌筋膜韧带悬吊固定于眶外上缘侧骨膜，修复下睑皮肤软组织缺损或矫正下睑外翻畸形。临床应用56例，其中睑袋整形术后并发下睑外翻42例，下睑血管瘤6例，色素痣8例。结果全部病例经切除病变、睑外翻复位后，分离眼轮匝肌肌皮瓣悬吊固定，创面直接缝合。伤口Ⅰ期愈合，无下睑外翻，已有外翻消失，随访3个月至3年，切口瘢痕不明显。结论埋没导引缝合法修复下睑皮肤软组织轻中度缺损，尤其矫正睑袋去除术后并发睑外翻畸形，安全有效、瘢痕细小，美容效果好。     

多方法合用修复睑袋术后并发严重下睑外翻

目的 睑袋术后并发严重下睑外翻是一种难以修复的畸形，探讨以多种方法联合应用修复严重下睑外翻的手术效果。方法 对于严重下睑外翻，应用颢浅动脉额支为蒂的额部岛状皮瓣转移、下睑水平缩短及下睑埋没导引缝合等多种方法予以修复。结果 2001年3月至2004年3月之间，应用上述方法共修复10例15只因下睑袋整形而导致的严重下睑外翻。对于大多数病例，应用额部岛状皮瓣转移修复即可。但对于更严重的外翻则需要同时进行下睑水平缩短和下睑板埋没导引缝合这几种方法的联合应用才能取得有效的修复效果。结论 颞浅动脉额支为蒂的额部岛状皮瓣转移、下睑水平缩短和下睑板的埋没导引缝合这三种方法联合应用可以可靠而稳妥地修复睑袋整形手术后并发的严重下睑外翻。     

应用帽状腱膜网状三维固定技术的全面部上提术

目的探讨埋没导引技术在上提面颈部年轻化手术中的持久效果。方法以颅骨为支撑,在帽状腱膜上下,用缝合线导引针进行三维立体概念的埋没导引缝合网状悬吊固定,注重力学分担,注重X、Z轴面组织的缝合分担受力,在Y轴整体上提下垂的面颈部软组织。结果本组共580例患者。术后随访3~13年,所有患者对手术效果满意,无面部瘢痕、头部脱发、血管神经损伤等并发症发生。结论应用埋没导引缝合技术行头部网状布线,实现三维立体缝合固定的面颈部软组织上提年轻化手术,符合力学原理,安全、有效,可达到持久的美容效果,值得临床推广应用。     

改良的阴道紧缩术

目的:探讨更安全有效的阴道紧缩方法。方法:应用埋没导引缝合技术行保留粘膜的阴道两侧壁紧缩术22例,不切除阴道粘膜,经阴道两侧壁处女膜痕处切口,应用埋没导引缝合技术,紧缩阴道两侧肛提肌。结果:所有患者无并发症,部分患者随访半年到两年,效果良好。结论:该方法安全简单可靠,有推广应用价值。     

《埋没导引缝合技术》出版

《埋没导引缝合技术》一书由广东科技出版社出版发行，李森恺教授主持编写。埋没导引缝合技术的核心要求是：从疾病的本质出发，以整形外科原则为准绳，在详细掌握局部解剖层次的基础上，采用隐蔽小切口的潜行分离和埋没导引缝合技术手段，实现微创的组织调整和组织移植，该书详尽地介绍了整形美容手术的实用方法，     

应用去神经足(足母)短、趾短伸肌游离移植结合埋没导引缝合技术治疗晚期面瘫

目的探讨治疗晚期面瘫更为有效的手术方法。方法采用足短伸肌、趾短伸肌游离移植和带蒂颞肌筋膜瓣转移结合埋没导引缝合技术综合治疗晚期面瘫432例。结果354例患者获得面部表情静态对称和动态基本对称的良好效果;52例患者面部表情静态对称较理想而动态对称不足;26例患者面部表情具有一定的动态恢复,而静态对称不足,经再次手术悬吊获得比较满意的效果。有4例患者出现术后感染,2例在足部供区,2例在面部,经引流和抗炎治疗,均于3周内治愈,对手术效果没有明显影响。我们对46%的患者进行了复诊或电话随访,随访时间最长12年,最短1年,平均28个月。93%的患者对治疗效果满意,7%的患者认为治疗虽然使面部畸形明显改善,但表情对称性尚不充分。结论足短伸肌、趾短伸肌游离移植结合埋没导引缝合技术可以有效地治疗晚期面瘫,手术方法简单,组织损伤小,术后并发症少,值得推广。     

《埋没导引缝合技术》出版

《埋没导引缝合技术》一书已由广东科技出版社出版发行，李森恺教授主持编写。埋没导引缝合技术的核心要求是：从疾病的本质出发，以整形外科原则为准绳，在详细掌握局部解剖层次的基础上，采用隐蔽小切口的潜行分离和埋没导引缝合技术手段，实现微创的组织调整和组织移植，该书详尽介绍了整形美容手术的实用方法，可以做为一类新手术方法开拓人们的视野。适合整形、美容、口腔、小儿外科、普通外科等专业的临床医师和研究生阅读和参考。     

改良埋没垂直褥式美容缝合技术在急诊颌面部外伤中的应用效果

目的：探讨改良埋没垂直褥式美容缝合技术在颌面部外伤患者早期急性修复中的临床应用效果。方法：回顾性分析2020年7月-2021年6月笔者科室因颌面部外伤急诊行美容缝合的2 339例患者临床资料，所有患者皮下组织采用改良埋没垂直褥式缝合，表皮采用小针细线的间断缝合，术后进行随访及总结分析。结果：本组2 339例患者中，有6例患者出现局部感染，再次行清创缝合后伤口愈合良好；有3例患者术后出现瘢痕疙瘩，行注射治疗后瘢痕减轻；有1例患者创缘出现张力性水疱，经换药处理后创面愈合，未留瘢痕；瘢痕视觉模拟量表评分为（2.95±2.17）分，大部分患者对治疗效果表示满意。结论：颌面部外伤急诊条件下采用改良埋没垂直褥式美容缝合技术，可减轻术后瘢痕，实现满意的修复效果。     

应用局部肌组织瓣改形充填面部凹陷性瘢痕

目的 应用局部改形肌组织瓣充填修复面部凹陷性瘢痕的缺损部位，以达到面部凹陷性瘢痕切除术后其周围组织形态恢复正常。方法 根据受伤部位、形状、面积及凹陷程度和肌肉、神经的损伤范围，应用正常肌组织瓣改形后逐层无张力缝合，修复凹陷部位。结果 面部凹陷性瘢痕术后即平整、切口隐蔽，6个月～1年随访切口瘢痕不明显，肌肉运动协调，周围组织平整、柔软。结论 局部肌组织瓣改形充填面部凹陷性瘢痕术。不仅适用于外伤感染所致的面部凹陷性瘢痕。也适用于烧伤后瘢痕、瘢痕疙瘩等改形手术。     

埋没导引缝合技术在矫正假体隆鼻术后部分并发症中的应用

目的 探讨埋设导引缝合技术矫正假体隆鼻术后部分并发症的效果.方法 采用埋没导引缝合技术矫正隆鼻术后假体偏斜、浮动、下沉等并发症.结果 38例矫正假体隆鼻术后形态良好,出现鼻假体偏斜、浮动、下沉移位的患者,均获得较满意效果.结论 采用埋没导引缝合的方法可在无创和微创的情况下使假体相对稳定,促使扩大、多余的腔穴紧密粘连、缩小,最后达到紧密包裹,使假体偏斜的位置矫正,并保持在理想的位置.此方法手术效果良好,是临床可以借鉴的方法之一.     

A new method using epidural catheters in the reconstruction of lacrimal drainage.

Lacrimal outflow obstruction after severance of the duct is a common problem in facial trauma. Conventional treatments include external dacryocystorhinostomy, endoscopic-assisted dacryocystorhinostomy, conjunctivorhinostomy, and a Jones tube bypass. However, the disadvantages of these methods are that the procedures are complicated and there is a high rate of recurrence. From April 2000 to March 2003, seven patients with epiphora after facial trauma had their lacrimal ducts drained with epidural catheters. The V-M shape incision was used with an epidural catheter placed as a stent for six months. After removal of the tube, all patients recovered fully from the epiphora during the follow-up period, and there were no complications.     

小切口筋膜缩紧面部提升术的临床应用探讨

目的：了解小切口筋膜缩紧面部提升术的操作要点及此方法的优点,探讨此术式的改进方向。方法：总结我科实施面部提升术的31例面部松垂患者,比较各种手术方法的治疗效果。结果：大切口除皱术的有7例,患者术后面部皱纹改善明显,2例鼻唇沟、口颊沟改善不够明显,2例过矫者面部表情僵硬,面部肿胀、青紫时间较长,切口周围麻木感较明显,切口痕迹较明显;24例小切口筋膜缩紧面部提升术术患者面部皱纹、鼻唇沟、口颊沟改善明显,术后面部青紫、肿胀不明显。结论：小切口面部提升术是治疗面部松垂比较理想的方法,疗效明显,创伤小、恢复快,效果较持久,术后患者满意率高,值得推广。     

冠状切口术后颞部凹陷相关危险因素的筛选

【摘要】 目的 筛选冠状切口术后颞部凹陷的相关危险因素。方法 收集采用冠状切口入路行眶颧复合体骨折修复术的87例患者作为观察对象,观察患者术后骨折复位及颞部凹陷情况,使用Logistic回归法对产生凹陷的危险因素进行筛选。结果 所有患者骨折愈合良好,但有11例在术后4~7个月出现颞部凹陷(占12.64%);受外伤至手术的时间、骨折类型、手术入路、颧骨体的移位、脂肪垫的移位或萎缩是术后颞部凹陷的危险因素(P<0.001,模型分类判对率超过85%)。结论 伤后早期手术、根据不同的骨折类型选择后合适的手术入路,术后加强随访明确骨体及脂肪垫的移位情况,可能有利于降低术后颞部凹陷的发生率。     

面部美容式缝合技术在面部创伤患者中的应用效果

目的 研究面部创伤患者在治疗期间应用面部美容式缝合技术的临床效果。方法 选择2021年 1月-2022年10月在我院接受手术治疗的面部创伤患者46例,根据手术所选缝合技术的不同将其分为对照 组和治疗组,每组23例。对照组实施普通清创缝合,治疗组实施面部美容式缝合,比较两组临床指标（手 术时间、水肿持续时间、疼痛消失时间、伤口愈合时间）、治疗效果、不良反应、皮肤切口状态、疼痛 （VAS）及心理状态（SAS、SDS）评分。结果 治疗组手术时间、水肿持续时间、疼痛消失时间、伤口愈 合时间均短于对照组（P ＜0.05）;治疗组治疗总有效率高于对照组（P ＜0.05）;治疗组渗出、硬结发生 率均低于对照组（P ＜0.05）;治疗组皮肤切口各项指标优于对照组（P ＜0.05）;两组治疗后VAS、SAS、 SDS低于治疗前,且治疗组低于对照组（P＜0.05）。结论 面部创伤患者在治疗期间应用面部美容式缝合技 术,能够帮助迅速改善皮肤状态,有效控制瘢痕增生,减轻疼痛,使患者保持良好心理状态,缩短愈合时 间,减少不良反应,使治疗效果得到提升。     

Recovering maxillofacial trauma patients: the hidden problems

This longitudinal study highlights the psychological and functional problems that can result from maxillofacial trauma. This is the first study to report outcome at one year. A total of 147 patients admitted for surgery following facial trauma were recruited over a seven-month period. Three questionnaires were used to record patient-derived levels of dysfunction: the Hospital Anxiety Depression scale, a modified University of Washington Quality of Life questionnaire and five non-validated facial trauma items. At one year 46 patients (31%) responded. Although there were significant improvements in scores from pre-operatively to one year, with all patients being discharged from outpatient follow-up, there was a substantial level of subjective symptomatology. Most notable was the level of anxiety and depression, which were present in 30% of the sample at both time points. Health-care professionals tend to underestimate the long-term effects of maxillofacial trauma. To improve patient care, greater appreciation of these problems is required at the time of initial management.     

睑缘切口联合耳颞切口行颧骨复合体骨折内固定

目的 探讨睑缘切口联合耳颞切口进行颧骨复合体骨折复位内固定的临床应用效果.方法 53例颧骨复合体骨折患者,采用睑缘下切口联合耳颞切口进行骨折复位及坚固内固定,观察术后患者面部外形、开口度、咬合关系、神经损伤、视力、眼球运动以及手术瘢痕等变化.结果 全部患者均Ⅰ期愈合,面部畸形明显改善;开口度、咬合关系恢复正常;复视及眼球运动障碍得到改善;眶下神经及面神经损伤的患者均有不同程度的恢复,并有部分患者完全恢复;没有出现因手术而导致的面神经颞支、眶上神经永久性损伤,术后部分患者面神经颞支有不同程度的暂时性损伤,1～3个月均完全恢复,无颞肌萎缩现象;无眼睑水肿、睑外翻、睑内翻出现;眼睑及耳颞部瘢痕隐蔽,不影响美观.结论 睑缘切口联合耳颞切口进行颧骨复合体骨折的复位与坚固内固定,不但术野显露充分利于复位与内周定,而且手术后瘢痕隐蔽,不影响美观,也无明显手术并发症发生.     

改良真皮下缝合技术在急诊面部外伤中的应用

目的 探讨一种改良型真皮下缝合技术在急诊面部外伤清创术中的应用,以期达到良好美容效果.方法 对78例急诊外伤患者采用改良真皮下精细缝合技术进行清创缝合.结果 78例患者全部一期愈合.随访半年后有63例患者得到随访.除5例挫裂伤较重的患者,伤口瘢痕增生、变宽,予以二期修复外,其余伤口瘢痕均很淡化、细微,治疗效果满意.结论 改良真皮下缝合技术应用于急诊面部外伤清创中,可以达到一期美容效果,避免二期美容修复.     

Results of reconstruction of the facial nerve

The results of surgical treatment for facial paralysis are still difficult to compare as there is no universal scoring method. The purpose of this communication is to review the results of reconstruction of the extratemporal facial nerve with nerve grafts using our own evaluation system. Fifty-nine patients were operated on during the period 1981–1991. They had lacerations or other trauma to the face which resulted in loss of continuity of the facial nerve or branches. Three groups were considered: (a) 12 patients had injuries involving the trunk and extending up to the main branches of the facial nerve; (b) 32 patients had parotid laceration or contusion on the parotid area with resulting nerve defects extending from a main branch up to distal branches; and (c) 15 patients had injuries on the distal branches: frontal, zygomatic, or mandibular. The sural nerve was used as the graft in all instances. The grafting procedure was performed from three weeks to six months after the trauma. The method of evaluation compares the normal with the paralyzed side. A score is given of 0 (no motion), 1 (weak motion), or 2 (strong motion), for each of six voluntary contractions: forehead, closure of eyelids and lips, traction, elevation, and depression of the lips. The assessment of involuntary mimic actions was done while observing blinking, speaking, smiling, and laughing. Mass movements were scored negatively. The numbers were recorded and the ratio between the paralyzed and normal side gave an estimate of the lack of symmetry. Differences between the preoperative and postoperative scores showed that improvement had been achieved by surgery. Nerve grafting provided a significant improvement of function in patients with traumatic injuries to the extratemporal facial nerve. © 1994 Wiley-Liss, Inc.     

The association between depression and anxiety disorders following facial trauma—A comparative study

Aim

Although the surgical care provided for patients who have sustained a maxillofacial injury has advanced in recent years, psychological disorders may develop. Anxiety and depression may be a cause of significant morbidity in these patients. Such problems are often unrecognised and untreated.

Patients & methods

We undertook a comparative cross-sectional study in a cohort of adult patients to assess the association between traumatic facial injury and the presence of anxiety and depressive disorders. Study subjects were recruited during the period of June 2008 through August 2008. Fifty consecutive adult patients attending the maxillofacial outpatient clinic following facial trauma were asked to complete the Hospital Anxiety and Depression Scale (HADS). Data gathered from this group of patients were compared to 50 adult control subjects who were under follow-up following elective oral and maxillofacial surgery. We also looked at several demographic and other variables to assess its association with poor mental health outcomes.

Results

Ten patients (20%) in the facial trauma group achieved high scores in both subscales suggesting a probable anxiety and depression state. The mean score for the depression subscale was significantly higher in the facial trauma group compared to the control group (p = 0.006). The mean score for anxiety was also higher but did not reach statistical significance (p = 0.07). Stratified analysis (Mantel-Haenszel) was used to control for possible confounding variables. The odds ratio for probable depression, for facial trauma patients compared with “control” patients, was 9.02, 95% CI = 2.45, 33.1, p < 0.001. Variables with significant associations (p < 0.05) with high depression scores in the facial trauma group were female sex, presence of a permanent facial scar, and a past psychiatric history. There was also significant correlation between patients’ self-perception of facial disfigurement scores and scores obtained in both anxiety subscale (r = 0.41, p = 0.003) and depression subscale (r = 0.46, p = 0.001).

Conclusion

Our results support the findings of previous studies and provide further evidence to clinicians for the critical identification and treatment of anxiety and depression in facial trauma victims.     

动静结合的面神经瘫痪综合治疗

目的 探讨静态和动态结合综合治疗面神经瘫痪的方法。方法 1993年10月～2005年11月治疗了面神经瘫痪93例，男26例，女67例；年龄9～69岁。病程6个月～24年。不明原因发病48例，有颅内及耳手术史32例，外伤13例；其中全面神经瘫82例，向神经分支瘫11例。针对面神经瘫痪的不同情况（全瘫和分支瘫）采用了不同的修复方式，动态修复术包括手术和生物化学去神经足雌短伸肌、趾短伸肌游离移植联合颍肌筋膜瓣悬吊面瘫矫治；静态修复包括颧颊部组织上提联合颞肌筋膜瓣矫治眼闭合不全，埋设导引缝合眉上提术（单纯颞支损伤可单独应用），下颌缘支损伤采用肉毒毒素注射及健侧下颌缘支离断的两侧肌力调节。对于静态修复者，疗效的评价标准主要足面部的对称性检查，而动态修复者是联合面部对称性检查及House-Brackmann面神经功能国际评分。结果 手术和化学去神经足拇、趾短伸肌游离移植联合颞肌筋膜瓣悬吊面瘫矫治82例，面部基本对称77例，改善5例；Ⅱ级75例，Ⅲ级7例。颧颊部组织上提联合颞肌筋膜瓣矫治眼闭合不全3例，面部基本对称。埋设导引缝线眉上提术治疗15例，面部基本对称13例、悬吊脱落2例。下颌缘支损伤肉毒毒素注射及健侧下颌缘支离断的两侧肌力调节4例面部基本对称。术后随访3个月～10年，取得了较好的效果，按疗效评价标准：满意者75例，基本满意者13例，不满意者5例。采用小肌肉游离移植，短暂去神经肌肉移植后利于周围神经的长入，手术切口隐蔽，肉毒毒素的应用减少了创伤；动态和静态结合的个性化面神经瘫痪治疗，面部的改观较明显。结论 面瘫治疗需要根据面神经瘫痪不同的情况采取不同的治疗方法。