骨膜为蒂的颞深筋膜瓣在标准外伤性大骨瓣开颅硬脑膜减张缝合中的应用研究

目的探讨骨膜为蒂的颞深筋膜瓣在标准外伤性大骨瓣开颅硬脑膜减张缝合中应用。方法分析研究重型颅脑损伤标准外伤性大骨瓣入路开颅的患者74例,分为人工脑膜组36例和骨膜为蒂的颞深筋膜组38例,2组均行开颅血肿清除术+去骨瓣减压术并减张缝合硬膜,观察术后的硬膜间积液等并发症和经济负担。结果骨膜为蒂的颞深筋膜组术后无并发症,经济负担轻,与对照组比较有统计学意义(P<0.01)。结论骨膜为蒂的颞深筋膜瓣在标准外伤性大骨瓣开颅硬脑膜减张缝合的手术操作方法可以安全应用,是对标准外伤性大骨瓣开颅术的重要补充。     

颞肌、颞筋膜、颅骨骨膜复合组织瓣转位悬吊法矫治晚期面瘫

目的 探讨矫治晚期面瘫简单有效的动力性矫正手术方式.方法 将颞肌、颞筋膜瓣转位悬吊法作了如下三方面的改进：①利用颅顶部骨膜使颞肌、颞肌筋膜瓣得到适当延长和张力加强.②升高颞肌颞筋膜瓣转位下翻的平面.③采用硅胶丰颞片填充颞部供瓣区凹陷.结果 克服了原术式供瓣长度不足的缺陷,并获得了一条在组织结构上相延续的完整的颞肌、颞筋膜、颅骨骨膜复合组织瓣供转位修复,而且有效地避免了颞部供瓣区的凹陷畸形,较大程度地改善了术后颧部臃肿的外观.结论 改良后的术式成功地避免了原术式的不足,获得了较好的动力性矫治效果.     

内窥镜骨膜下剥离面部年轻化手术

为实现面部年轻化，自１９９５年７月起，用自行研制的内窥镜，日本产的电视转换系统，行骨膜下剥离除皱术共１５例，切口小而隐蔽，不脱发，术后肿胀较轻，并发症少，效果良好，就手术适应证，仪器设备，操作方法和结果进行了讨论，认为此种手术的最佳年龄是４０～５５岁，６０岁左右者需加作多层次剥离提紧或吸脂术，年龄再大者则非手术适应证，并强调头皮切口处最大限度地上推和固定对于保证手术效果的重要性。     

颞筋膜瓣和E-PTFE在面部皮下软组织缺损修复中的应用

目的：探讨颞筋膜瓣、e—PTFE在面部皮下软组织缺损修复中的应用价值。方法：应用颞筋膜瓣、e-PTFE并采用不同切口入路对面部软组织缺损进行修复。软组织充填多在皮下脂肪层下潜行分离，行颞筋膜、e—PTFE充填。结果：本组修复的患者术后均Ⅰ期愈合，面部轮廓改善理想，触诊手感自然，其中1例患者1月后修复区有一直径5mm大的皮肤坏死，其余均无其他并发症发生。结论：应用颞筋膜瓣、e—PTFE进行面部皮下软组织缺损充填是理想而损伤小且效果明显的修复方法。     

带蒂颞浅筋膜瓣复合真皮脂肪修复面部凹陷畸形的疗效评价

目的 对带蒂颞浅筋膜瓣复合真皮脂肪充填面部凹陷畸形的疗效进行初步评价。方法 对１０例面部凹陷畸形,其中５例半面萎缩,５例腮弓畸形患者进行随访和对比研究。结果 经随访１～３年发现,该法用于由腮弓畸形所致的面部凹陷优于半面萎缩的治疗。用于腮弓畸形的充填,复合组织瓣的后期吸收率低,能获得满意的远期丰满外形,而用于半面萎缩病例,约有２０％～４０％的吸收率。结论 用该法治疗面部凹陷畸形,应注意引起凹陷的原因     

颞肌筋膜瓣与全厚皮片移植修复下睑凹陷性畸形

目的探讨颞筋膜瓣或颞肌筋膜瓣与自体全厚皮片移植,在下睑凹陷性瘢痕畸形修复中的应用效果。方法设计以颞浅动脉为蒂的颞筋膜瓣,对伴眶下壁骨缺损者同时行以颞浅、深动脉为蒂的颞肌筋膜瓣,并取耳后全厚皮片移植联合矫正下睑凹陷性畸形。结果8例患者,术后组织瓣及皮片成活良好,凹陷处填充效果满意。随访6个月至1年,睑外翻矫正,瘢痕不显,颞部供区毛发生长良好。结论应用颞筋膜瓣或颞肌筋膜瓣与全厚皮片移植,联合矫正下睑凹陷性畸形的方法,具有操作简便,且无明显的供区损害的特点,是修复下睑凹陷性瘢痕畸形较理想的方法。     

颞肌筋膜瓣与全厚皮片移植修复下睑凹陷性畸形

目的 探讨颞筋膜瓣或颞肌筋膜瓣与自体全厚皮片移植，在下睑凹陷性瘢痕畸形修复中的应用效果。方法 设计以颞浅动脉为蒂的颞筋膜瓣，对伴眶下壁骨缺损者同时行以颞浅、深动脉为蒂的颞肌筋膜瓣，并取耳后全厚皮片移植联合矫正下睑凹陷性畸形。结果 8例患者，术后组织瓣及皮片成活良好，凹陷处填充效果满意。随访6个月至1年，睑外翻矫正，瘢痕不显，颞部供区毛发生长良好。结论 应用颞筋膜瓣或颞肌筋膜瓣与全厚皮片移植，联合矫正下睑凹陷性畸形的方法，具有操作简便。且无明显的供区损害的特点，是修复下睑凹陷性瘢痕畸形较理想的方法。     

从颞浅筋膜瓣到其他部位脂肪筋膜瓣的应用进展

众所周知,创伤致人体软组织缺损,可用皮片或皮瓣移植进行修复.然而,利用带血运的筋膜瓣可以覆盖无血供或血供不佳的创面,筋膜瓣上面再进行皮片移植也可以一次修复创面.筋膜瓣是在筋膜皮瓣基础上发展起来的一种组织瓣,不包括皮肤,只有浅筋膜和深筋膜(2000年,徐传达).其中,游离的颞筋膜瓣是临床应用较多的筋膜瓣之一,为创面缺损的修复、软组织填充及耳郭再造提供了良好的供区.另外,随着临床工作的不断深入,身体其他部位的脂肪筋膜瓣也被用来进行创面覆盖或填充凹陷畸形以及用于半侧颜面萎缩和隆乳的治疗中.笔者通过复习文献,将颞筋膜瓣及身体其他不同部位,包括股前外侧区、肩胛区、前臂区以及同指掌侧脂肪筋膜瓣的临床应用综述如下.     

面部除皱术中颞浅筋膜瓣转移覆盖眼轮匝肌治疗鱼尾纹

目的 探讨面部除皱术中应用颞浅筋膜瓣转移覆盖眼轮匝肌治疗鱼尾纹的效果,并对手术操作经验进行总结.方法 在面部除皱术中,颞部处理按常规操作,首先在皮下组织层分离至颞线、眶外缘,然后在帽状腱膜、颞浅筋膜下分离,向前达眶上缘、眶外缘,在帽状腱膜、颞浅筋膜交界处剪开形成颞浅筋膜瓣,将其反转后铺垫于眼外侧的眼轮匝肌表面,用6-0可吸收线适当固定.结果 2004年5月至2010年5月临床治疗18例,术后随访6～12个月,与单纯除皱者相比,本组患者术后鱼尾纹矫正较持久,面部年轻化效果更好,手术效果满意,无局部不平整畸形等并发症出现.结论 除皱术中应用颞浅筋膜瓣转移覆盖眼轮匝肌来治疗鱼尾纹,效果较显著,疗效较传统除皱术更持久.     

经颞部骨膜下剥离面中部提紧术

目的探讨一种经颞部矫正面中部老化征象的简单而有效的方法。方法经颞部头皮切口在颞浅筋膜和颞深筋膜间剥离,下达颧弓,内达眶外侧缘。在颧弓上约2cm,平行颧弓切开颞深筋膜浅层约3cm,在颞深筋膜浅层下剥离至颧弓上缘进入骨膜下剥离。松解面中部。将已充分活动的面中部全层组织上提,缝合固定于颞深筋膜表面。结果自2000年以来,临床应用21例,术后效果满意,外观自然,无并发症发生。结论本方法具有手术时间短,剥离层次深,耳前无切口,术后恢复快,效果自然,维持时间长的优点。选择合适的病例,能获得满意的效果。     

Subperiosteal facelift: Open and endoscopic approach

The endoscopic subperiosteal facelift as an isolated procedure is indicated for patients with grade I rhytidosis. It is also indicated in cases of grades II and III rhytidosis in males in whom the coronal incision is contraindicated due to alopecia and without conspicuous damage to the forehead. In these cases, the procedure is combined with subcutaneous rhytidectomy of the neck. It can also be used in cases of secondary facelift. The small incisions used in this procedure allow sufficient and effective access for dissection and suspension of the tissues released during the facelift. The coronal incision is not necessary, thus avoiding the resulting discomfort and scar. These patients do not receive anesthesia and experience almost no paresthesia in the frontal region, as in cases in which a coronal incision is performed. The endoscopic approach reduces surgical trauma as well as postoperative edema. Since neither the veins nor the lymphatic vessels of this area are sectioned, swelling subsides faster and recovery is shorter.     

经颞部骨膜下剥离面中部提紧术

目的探讨一种经颞部矫正面中部老化征象的简单而有效的方法。方法经颞部头皮切口在颞浅筋膜和颞深筋膜间剥离,下达颧弓,内达眶外侧缘。在颧弓上约2cm,平行颧弓切开颞深筋膜浅层约3cm,在颞深筋膜浅层下剥离至颧弓上缘进入骨膜下剥离。松解面中部。将已充分活动的面中部全层组织上提,缝合固定于颞深筋膜表面。结果自2000年以来,临床应用21例,术后效果满意,外观自然,无并发症发生。结论本方法具有手术时间短,剥离层次深,耳前无切口,术后恢复快,效果自然,维持时间长的优点。选择合适的病例,能获得满意的效果。     

Subperiosteal approach for periorbital neurofibromatosis

Summary A case of Von Recklinghausen neurofibromatosis is presented. The tumor was resected using a subperiosteal approach. The soft tissue reconstruction was accomplished by transposition of the complete temporalis muscle with a galeal periosteal extension to provide additional bulk.     

The tri-plane face lift dissection

This article reviews the author's series of 750 rhytidectomies done over an eight-year period, beginning with the earlier pure Skoog technique with no subcutaneous undermining and evolving into the present technique with widespread undermining except in the lower face. The current technique, which is a tri-plane dissection, is discussed in detail. The upper face dissection is in the subcutaneous plane. The lower face dissection is in the sub-SMAS plane and the neck dissection is in the preplatysmal plane. Ways to avoid post-operative neck deformities are discussed. The conclusion is that whether one undermines the skin of the lower face or not probably makes no difference in the aesthetic results, but this technique would appear to minimize complications, particularly hematoma formation.     

The “Biplanar” forehead lift

A new technique of forehead rhytidectomy is presented that combines the best features of the coronal incision with those of the anterior hairline incision. The plane of dissection is formed by an anterior subcutaneous plane dissecting a lateral subgaleal plane. This approach is particularly valuable in patients with high foreheads, severe static wrinkling, and asymmetrical eyebrows.Presented in part at the Annual Meeting of the American Society of Aesthetic Plastic Surgeons, Boston, MA, 1984     

Time-dependent mechanical behaviour of the aortic chronic dissection flap

Open in a separate window OBJECTIVESThe transition of aortic dissection from acute to chronic is poorly understood. We examined time-dependent mechanical behaviour and biochemical properties of chronic dissection tissues.METHODSAorta samples were obtained from 14 patients with mixed aetiology who were undergoing elective surgery for chronic dissected aneurysms, ranging from 3 months to 15 years post-dissection. The tissue elastic modulus and tissue deformation following application of loading for 5 h were measured for the false lumen (FL), true lumen (TL) and flap (FP) tissues with a custom-indentation technique. Collagen, elastin and glycosaminoglycan levels were determined with established biochemical assays. Elastin fragmentation was graded from histological sections. The number of tissues characterized was as follows: FP (n = 10), TL (n = 5 for biomechanical testing, n = 8 for biochemical analysis, n = 8 for histological assessment) and FL (n = 4).RESULTSTissues stiffness was highest in FP [59.8 (14.8) kPa] as compared with TL [50.7 (6.2) kPa] and FL [40.5 (4.7) kPa] (P = 0.023 and P = 0.006, respectively). FP [0.5 (0.08) mm] also exhibited reduced deformation relative to TL [0.7 (0.02) mm] and FL [0.9 (0.08) mm] (P = 0.003 and P = 0.006, respectively), lowest collagen concentration [FP: 40.1 (19.6) µg/mg, TL: 59.9 (19.5) µg/mg, P = 0.008; FL: 79.1 (32.0) µg/mg, P = 0.006] and the lowest collagen: elastin ratio [0.4 (0.1)] relative to the other tissues [TL; 0.6 (0.3), P = 0.006, FL; 1.5 (0.4); P = 0.003]. Significant elastin loss was evident in the FL-stained tissue sections whereas highly aligned, long fibres were visible in the FP and TL. A linear relationship was found between the stiffness, deformation and the time from the dissection event to surgical intervention for the FP. All data are presented as median (interquartile range).CONCLUSIONSFP exhibited reduced time-dependent deformation and distinct biochemical properties relative to TL and FL irrespective of connective tissue disorder or the anatomical region of the dissection.     

射频手术机器辅助内窥镜骨膜下额颞部除皱术

目的探讨射频手术机器在内窥镜骨膜下额颞部除皱术中的应用。方法常规内窥镜骨膜下额颞部除皱术中,应用射频手术机器切割及凝固电极行骨膜下剥离,尤其是眶周和额颞移行区充分分离,仔细分离切割皱眉肌、降眉肌及部分额肌,松弛皮肤钛钉固定于颅骨外板。结果本组10例均获得满意效果。结论射频手术机器辅助内窥镜骨膜下额颞部除皱术,能准确分离切割额颞部肌肉,除皱效果确切、持久。     

全面颈部多层次分离提紧除皱术

目的根据面颈部不同组织老化的解剖学特点,行全面颈部多层次分离提紧除皱术,以提高手术效果。方法解剖额、颞、面、颊、鼻唇沟以及颈部的多层组织,提紧皮肤及骨膜层,游离眶上神经血管束,离断额肌、皱眉肌及降眉肌,分离和提紧面颊部及鼻唇沟区域的SMAS,分离和悬吊颈阔肌等。结果自2002年1月至2006年6月,采用全面颈部多层次分离提紧的方法对54例患者行除皱术。术后随访所有患者2个月至4年,效果满意,无明显并发症发生,治疗有效率为86%。经t检验,手术前后比较差异有统计学意义（P〈0.05）。结论全面颈部多层次分离提紧除皱术,是矫正患者面颈部不同解剖结构老化的较好的手术方法,值得在临床上推广应用。