即时二次隆乳术的探讨

目的:探索处理隆乳术后并发症同时行二次隆乳术适应证,选择适合手术切口,放置适当组织间隙。方法:36例隆乳并发症患者(其中硅胶假体隆乳13例,聚丙烯酰胺水凝胶注射隆乳23例)行即时二次隆乳,采用乳房下皱襞切口或乳晕切口,隆乳材料均选用硅胶假体。结果:该方法具有安全、易操作、痛苦小,出血少的优点,经随访3个月至3年取得满意效果。结论:严格掌握手术适应证,聚丙烯酰胺水凝胶(PAHG)尽可能洗净,选择硅胶假体置入胸大肌下间隙,是即时二次手术隆乳术的最佳方法。     

腋窝与乳晕切口乳腺后间隙隆乳术对比体会

目的:探讨腋窝入路与乳晕入路行乳腺后间隙假体隆乳术的优缺点.方法:选取腋窝入路与乳晕入路行乳腺后间隙假体隆乳术患者各30例,对比其优缺点.结果:两种手术方式,术后乳房形态、手感、乳房活动度无明显差别.结论:腋窝入路的乳腺后间隙假体隆乳术,无乳腺导管损伤的风险,无乳晕瘢痕,对于难以接受乳晕切口的患者来说,是一个良好的手术方式     

胸肌筋膜后间隙假体置入隆乳术

目的探讨胸肌筋膜后间隙（即胸肌筋膜和胸大肌之间间隙）假体置入隆乳术的可行性。方法经乳晕切口，将硅凝胶乳房假体放置于胸肌筋膜和胸大肌之间。结果术后随访6～14个月，23例除1例双侧乳房轻度不对称外，其余各例乳房外形良好，未见假体扭曲，假体边缘不明显，无血肿、感染等并发症发生。结论胸肌筋膜后间隙可作为隆乳术乳房假体置入部位，具有操作简单、安全、康复快、并发症低和乳房外形良好等优点。     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的　一次性完成隆乳并矫正乳房轻度下垂。方法　经乳晕上切口切除半月形皮肤 ,不切开乳腺置入乳房假体 ,将乳腺组织上移悬吊固定于胸大肌深筋膜。结果　 2 3例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好 ,乳晕切口瘢痕不明显 ,乳头感觉及勃起正常。结论　该方法隆乳同时矫正下垂乳房效果可靠稳定 ,创伤小 ,止血彻底 ,瘢痕不明显。     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的一次性完成隆乳并矫正乳房轻度下垂.方法经乳晕上切口切除半月形皮肤,不切开乳腺置入乳房假体,将乳腺组织上移悬吊固定于胸大肌深筋膜.结果 23例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好,乳晕切口瘢痕不明显,乳头感觉及勃起正常.结论该方法隆乳同时矫正下垂乳房效果可靠稳定,创伤小,止血彻底,瘢痕不明显.     

改良乳晕切口隆乳术及假体置放技巧

为了更好地开展乳晕切口隆乳术，我科自１９９４年以来，对７例患者采用改良的乳晕内上或内下弧形切口，及单指置放假体的技巧，在胸大肌下间隙置放硅凝胶假体，术后乳房形态满意，随访３个月至１年无乳头乳晕感觉减退，感觉异常及纤维挛缩等并发症。本方法通过小切口置放大容量假体，手术操作简便易行，避免了神经损伤，使切口隐蔽的乳晕切口隆乳术具有更高的实用价值。     

经乳晕上切口矫正轻度下垂乳房的隆乳术

目的 一次性完成隆乳并矫正乳房轻度下垂。方法 经乳晕上切口切除半月形皮肤，不切开乳腺置入乳房假体，将乳腺组织上移悬吊固定于胸大肌深筋膜。结果 23例乳房轻度下垂的小乳症患者术后乳房及乳头形态位置良好，乳晕切口瘢痕不明显，乳头感觉及勃起正常，结论 该方法隆乳同时矫正下垂乳房效果可靠稳定，创伤小，止血彻底，瘢痕不明显。     

内窥镜辅助下双平面隆乳术

目的:探讨双平面法经腋窝入路假体隆乳术中应用内镜辅助技术的临床效果,并总结手术要点。方法:选取36例内镜辅助技术下行双平面法经腋窝入路假体隆乳术患者,先设计拟置入假体所需剥离的上极、内侧、外侧、新的乳房下皱襞范围及胸大肌离断线,再切开双侧腋窝皮肤并分离,常规剥离胸大肌后间隙,在内窥镜辅助下,离断部分胸大肌,置入假体,术后留置负压引流管。结果:所有患者均顺利完成手术,手术时间(100.3±34.5)min,术中出血量(25.6±4.6)ml;术后引流(4.8±2.0)天,单侧乳房引流量为(200.3±65.8)ml。术后随访1年,无明显乳头、乳晕感觉丧失,1例(2.78%)出现包膜挛缩,Baker II级,余35例乳房外形丰满圆润、手感柔软,活动度好,无假体移位及双峰乳形等并发症。结论:在内镜辅助技术下行双平面法经腋窝入路假体隆乳术,术后乳房外形逼真,手感柔软,活动度好,无明显并发症发生,安全可行。     

丘状小乳症的临床治疗探讨

目的:探讨丘状小乳症的病因及手术治疗方法。方法:对我科近一年来4例采用乳房假体矫正丘状小乳的病案进行总结,比较假体置入时同期行乳腺后放射状切开、梯田状切开及乳晕双环法缩小后的治疗效果。结果:单纯假体隆乳术后双乳呈葫芦状,形态不佳;假体置入同时行腺体后放射状切开的1例患者术后乳房仍呈葫芦形,程度较轻;假体置入同时行乳腺后梯田状切开的1例患者术后疗效与放射状切开相似;2例假体置入同时行乳晕旁双环法上提的患者获得满意的疗效。结论:丘状小乳症是比较少见的乳房畸形,此类患者未生育前乳腺覆盖胸壁的面积小(远小于正常乳房基底面积),生育时哺乳期乳腺增生、增大导致乳头、乳晕四周皮肤小面积被牵张,又因哺乳导致乳头、乳晕及四周皮肤小面积松弛下垂,这样就导致乳晕及其旁侧的皮肤松弛度大于基底轮廓线外的胸壁皮肤。此类患者最佳的手术治疗方法是行乳房假体置入的同时用双环法矫正乳晕四周的皮肤松弛畸形。     

国外美容医学最新研究与进展(四)

隆乳的相关资料:(1)即时置放假体行隆乳术后手术区晚期的感染发生率;(2)对曾行保留乳头的乳房切除术者行乳头切除和重建术;(3)对曾有乳房瘢痕者采用保留乳头的乳房切除术是否安全;(4)无细胞真皮基质与乳房假体即时置入性隆乳术后短期的并发症。     

An Individualized Approach to Abdominoplasty in the Presence of Bilateral Subcostal Scars after Open Gastric Bypass

BACKGROUND: Patients requiring surgical skin excision after massive weight loss are challenging and require an individualized approach. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars from open gastric bypass surgery in the upper abdomen, which compromise blood supply of the abdominal skin. METHODS: We propose four different surgical techniques for safe abdominal body contouring in the presence of such scars: (1) a limited abdominoplasty of the lower abdomen is performed, and then contouring is completed by a reversed abdominoplasty with scar positioning in the submammary folds; (2) a one-stage procedure characterized by skin resection in the upper and lower abdomen, in which blood supply of the skin island between the submammary and suprapubic incisions is ensured by periumbilical perforators; (3) a perforator-sparing abdominoplasty with selective dissection of periumbilical abdominal wall perforators to secure flap blood supply and allow complete flap undermining up to the xyphoid process; (4) for patients with extensive excess skin, a modified Fleur-de-Lys abdominoplasty performed in such a way that the old transverse scar is transformed into a vertical scar. RESULTS: The treatment of four exemplary patients is described. All techniques yielded good esthetic and functional results through preservation of abdominal blood supply. CONCLUSION: Through an individualized approach, adequate abdominal body contouring can be performed safely, even in the presence of transverse surgical scars in the upper abdomen.     

应用肿胀麻醉技术微创小切口治疗中重度男性乳房发育症

目的：寻找一种切口小、创伤小的治疗中重度男性乳房发育的手术方法。方法：应用肿胀麻醉技术,在局麻下作男性发育乳房的脂肪抽吸,同时取乳晕缘小切口切除增生肥大的腺体。结果：21例男性乳房发育患者肥大的乳房减小,切口瘢痕小且隐蔽。随访6～60月,无复发。结论：对于中重度男性乳房发育症,应用肿胀麻醉技术微创小切口出血少、切口小、创伤小,是一种治疗该病的理想的手术方法。     

Reconstruction of perforated defects

12 cases of perforated defect were successfully repaired with lining flaps and covering tissues since 1982. The writers emphasized that the perforated defects happened more frequently on maxillo-face than on others. This paper reported 7 out of 12 cases. After the carcinomas or other tumors had been excised or treated by radiotherapy the defect of local skin may occur easily. Operations should be performed as early as possible no matter infections or scars exist. If every difficult present repairing operation shall finished on early and is not restricted with infection and scars. On the maxillofacial and neck region the sternocleidomastoid or latissimus dorsi myocutaneous flaps should be selected as the covering tissues.     

PCNA在增生性瘢痕和慢性溃疡中的表达及意义

目的 研究增殖细胞核抗原（PCNA）在增生性瘢痕和慢性溃疡中的表达特征，探讨其与增生性瘢痕和慢性溃疡发生的关系。方法 采用免疫组织化学SP法检测8例增生性瘢痕和8例慢性溃疡组织中的PCNA表达量及其定位。结果 在所测定的16例标本中均有PCNA阳性表达，且PCNA在增生性瘢痕中的表达量明显高于慢性溃疡组织（P＜0．01）。两种组织中PCNA表达定位于成纤维细胞和毛细血管内皮细胞内皮细胞的胞核内。结论 PCNA在增生性瘢痕中的表达量较高，而在慢性溃疡中的表达量较低，PCNA的不同表达量可能与增生性瘢痕和慢性溃疡的形成有关。     

Reduction mammoplasty and mastopexy: A personal technique

Surgical correction of the ptotic or hypertrophic breast is performed with increasing frequency. Many different techniques are widely practiced and give predictably reliable results. Greater consideration needs to be given to the long-term aesthetic results, breast shape, quality of scars, and preservation of nipple sensation. This paper presents a personal technique practiced for the past 10 years in which consideration is given to achieving better nipple projection and less conspicuous scars. In addition, a method of wide tissue overlapping is advocated to maintain better long-term breast contour.     

Perforator-Sparing Abdominoplasty Technique in the Presence of Bilateral Subcostal Scars after Gastric Bypass

Background The number of patients after gastric bypass being referred to plastic surgery units for secondary plastic surgery procedures is increasing. The characteristic abdominal deformity includes a draping apron of panniculus, occasionally associated with previous transverse surgical scars in the upper abdomen. Often a limited abdominoplasty of the low transverse type with limited undermining only up to the level of the umbilicus is performed in order not to compromise blood supply in the zone between the old transverse and the new transverse scar. Method We propose a new, modified and safe surgical technique to perform a complete abdominoplasty with wide undermining up to the xiphoid process in patients with preexisting transverse subcostal scars after gastric bypass surgery, by selectively dissecting and preserving one to three periumbilical abdominal wall perforator vessels to secure flap blood supply. Vessel tunnelling through the rectus sheath and muscle and ligation of the cephalad branch of the perforator provide sufficient flap mobility without perforator tension or traction. Flap undermining is performed around these perforator vessels. To match dissected flap perforators with blood-flow, we performed postoperative color-flow duplex scanning. Results We treated two patients according to this new technique. In both cases the postoperative course was uneventful and a good aesthetic result was achieved. Conclusion We conclude from our experience that with this perforator-sparing abdominoplasty technique, safe and complete abdominoplasty can be performed with no additional risk of complications and that a good cosmetic result can be achieved in patients after open gastric bypass surgery.     

Analysis of scar formation after lower limb lengthening: influence on cosmesis and patient satisfaction

Limb lengthening aims to reduce limb length discrepancy, improve cosmesis, and permit more functional mobility. Scarring, however, is a major concern of patients. In this study 25 patients (27 lengthening sites) were assessed; 6 sites were lengthened with Orthofix and 21 sites with Ilizarov. Altogether, 452 pin tract scars were assessed. The mean scar length was 11.5 mm in the Ilizarov group (n=415) and 54.1 mm in the Orthofix group (n=37). The mean scar width was 5.6 mm in the Ilizarov group and 11.5 mm in the Orthofix group. The mean patient satisfaction was 7.3 in the Orthofix group and 5.5 in the Ilizarov group. The mean Vancouver score was 0.66 in the Ilizarov group and 3.1 in the Orthofix group. The scars were shorter and cosmetically better in the Ilizarov group, but patients were more satisfied in the Orthofix group because there were fewer scars. Patients were also more satisfied with the thigh scars than with the leg scars because clothing can easily cover the thigh scars.     

The lateral transhelical approach for correction of deformities of the external ear

Additional experience with the chondrocutaneous flap in the repair of auricular defects showed that (i) the entire medial surface of the auricle can be easily and rapidly exposed through this approach, and (ii) the transhelical scar on the lateral surface of the ear remains inconspicuous. The skin of the lateral surface of the ear is similar to that of the eyelids and forms flat, smooth scars which do not hypertrophy. Furthermore, these scars are hidden under the curl of the helix. Through this approach, correction of the protrusion can be accomplished by any method or combination of methods which call for manipulation on the medial surface of the auricle. The scar is remote from the site of manipulation of the cartilage. An additional advantage of this procedure is that it can be combined easily with a small reduction in the size of the scapha.     

Treatment of Atrophic Facial Scars with Combined Use of High-Energy Pulsed CO2 Laser and Er:YAG Laser: A Practical Guide of the Laser Techniques for the Er:YAG Laser

BACKGROUND: Although CO2 laser resurfacing provides substantial clinical improvement for atrophic facial scars, the CO2 laser often results in excessive thermal damage to the skin. It increases complications postoperatively. The Er:YAG laser ablates thinner layers of tissue than the CO2 laser with minimal thermal damage to the surrounding skin. OBJECTIVE: To determine the efficacy of combined treatment of atrophic facial scars with high-energy pulsed CO2 laser and Er:YAG laser. METHODS: One hundred fifty-eight patients were treated with a combination of high-energy pulsed CO2 laser and Er:YAG laser for atrophic facial scars. All patients were evaluated after 3 months of treatment. RESULTS: The scars improved 80-89% in 65 patients, 70-79% in 56 patients, more than 90% in 32 patients, 60-69% in 2 patients, and less than 60% in 3 patients after laser treatment. CONCLUSION: Treatment of atrophic facial scars with combined use of high-energy pulsed CO2 laser and Er:YAG laser is a very effective and useful method.     

Evaluation of the hemi-Cincinnati incision for posteromedial soft-tissue release in clubfoot

Posteromedial soft-tissue release operations were performed on 42 idiopathic clubfeet in children younger than 2 years of age through the medial half of the Cincinnati incision (the hemi-Cincinnati incision). This incision gave adequate exposure to all structures to be released. Wound closure was possible in all 42 feet without having to hold the foot in plantarflexion or inversion. Wound healing was satisfactory in the majority of instances and 81% of the scars, assessed 9 months after the operation, were graded as excellent or good. The scar is located in an area of the foot that can be concealed easily and should a more radical soft-tissue operation be needed later, the same incision can be extended easily. The authors recommend this incision as the incision of choice for performing posteromedial soft-tissue release operations on clubfeet in children younger than 2 years of age.