悬吊预控张力方法在面部除皱手术中的应用

目的:在面部除皱术中,探索一种可降低伤口闭合张力,从而减轻瘢痕和秃发、维持长期提升效果的方法.方法:同时应用颧脂肪垫悬吊法、眼轮匝肌瓣悬吊法和颞部三点减张悬吊法三种悬吊方式,使伤口主要锚着点的闭合张力降低.结果:2006年至2011年,在68例面部除皱术中运用该方法,无明显伤口瘢痕增生和秃发,面部提升效果维持时间长,无面神经损伤并发症出现.结论:悬吊预控张力方法使张力重新分布到深层结构,明显减轻了伤口瘢痕增生和秃发,操作简单、安全、效果持久.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

颞部发际缘锯齿切口多部位递进式悬吊除皱术

目的 探讨颞部发际缘锯齿形切口多部位递进式悬吊除皱术与传统切口的除皱术在对中下面部提升及术后切口愈合和瘢痕隐蔽方面的优越性.方法 将40例患者分为A、B两组,A组16例采用发际缘锯齿形切口多部化递进式悬吊除皱术,并对眼轮匝肌、颧部、耳前行多部位递进式悬吊折叠缝合固定,切口方向为向前向内为40～45°;B组24例采用传统切口的除皱术.结果 A组患者切口愈合佳,且发际缘有毛发生长,瘢痕隐蔽性好,鱼尾纹明显减轻,下垂的外眦角、颧部、下颊部和腮腺咬肌区皮肤有较明显的提升,与B组相比较,差异有统计学意义(P<0.05).结论 颞部发际缘锯齿形切口多部位递进式悬吊除皱术是一种简便、安全有效且切口隐蔽的除皱方法,值得在临床上推广应用.     

可拆线皮内缝合法在骨科取内固定手术中的应用

目的比较可拆线皮内缝合法和传统缝合法在骨科区内固定手术应用疗效。方法从2009年5月到2010年9月．将162例接受骨科取内固定物患者随机分成两组。缝合切口时，A组81例用无损伤滑线做皮内连续缝合，B组81例用1#丝线做传统皮肤缝合．观察比较拆线时两组患者皮肤愈合、疼痛及3个月、6个月后切口瘢痕情况。结果A组无线结反应及感染情况，81例均为甲级愈合：拆线时瘢痕为一线形，平均宽约1mm，患者疼痛评分为1．5分，3个月瘢痕为一线形，平均宽约1．2mm；6个月后平均宽约1．5mm；病人满意度为96％。B组拆线时，75例明显“轨迹”样瘢痕，4例线结反应，2例浅表感染；平均宽约5ram患者疼痛评分为4．5分，3个月后瘢痕为“轨迹”样．平均宽约8ram；6个月后平均宽约12mm；病人满意度为34％。结论可拆线皮内缝合法和传统缝合法相比较，在骨科取内固定手术时应用有明显优势。     

辅助以内窥镜和吸脂术的除皱手术

目的 介绍辅助以内窥镜和吸脂术行面部除皱的手术方法及临床效果。方法 对于面部脂肪增生或脂肪下垂堆积及皮肤松弛者，行内窥镜额颞部上提，颊脂肪垫去除，面中、下部肿胀吸脂,深层组织的悬吊。结果 28例患者均获得良好的手术效果,面部外形明显变小,轮廓更加清晰,皮肤松垂得到复位,同时避免额颞部冠状切口,无脱发、瘢痕形成,无并发症（血肿,面神经损伤,皮肤坏死等）发生。满意率达100%。结论 避免了传统手术方法的大切口,同时也避免了头部的瘢痕、麻木等不良反应的出现,面部的软组织弹性更加良好、轮廓更加清晰。     

整形美容外科技术治疗急诊儿童面部外伤的效果

目的 探究对急诊儿童面部外伤采用整形美容外科技术的临床效果。 方法 选择我院2022年 1月-2023年2月收治的66例面部外伤患儿为研究对象,以随机数字表法分为常规组和试验组,每组33例。 常规组采用传统缝合技术,试验组采用整形美容外科技术,比较两组手术缝合时间、伤口愈合时间、治疗 费用及瘢痕情况。 结果 试验组手术缝合时间长于常规组,治疗费用高于常规组,伤口愈合时间短于常规组 （P＜0.05）;试验组VSS各项评分及总分均低于常规组（P＜0.05）。 结论 针对急诊面部外伤患儿采用整 形美容外科技术治疗的效果良好,虽然其缝合时间较长,且费用高于传统缝合技术,但能够有效缩短患儿 伤口愈合时间,有利于减轻瘢痕,促进恢复。     

美容缝合技术在面部外伤患者中的应用效果

目的 探讨美容缝合技术在面部外伤患者中的应用效果。方法 选取2021年1月-2022年6月我科 收治的80例面部外伤患者为研究对象,采用随机数字表法分为常规组和美容组,各40例。常规组行常规缝 合,美容组行美容缝合,比较两组缝合时间、缝合费用、术后伤口愈合情况、瘢痕主客观评价结果。结果 美容组缝合时间、缝合费用均高于常规组（P＜0.05）;美容组甲级愈合率为97.50%,高于常规组的87.50% （P＜0.05）;美容组满意度评分高于常规组,瘢痕面积、瘢痕长度小于常规组（P＜0.05）。结论 美容缝 合技术在面部外伤患者中的应用效果确切,相比于常规缝合方式,美容缝合技术虽然缝合时间稍长、费用 稍高,但伤口愈合情况更为理想,且术后瘢痕不明显,患者满意度较高,值得临床应用。     

Study of Two Techniques for Midline Laparotomy Fascial Wound Closure

To study the results of two techniques, simple interrupted closure and continuous with intermittent Aberdeen knot technique for midline laparotomy fascial wound closure. A random selection of 200 midline laparotomy cases was done. In one group (group A) of 100 cases, midline fascial wound closure was done with continuous sutures with intermittent Aberdeen knot technique using Prolene No. 1 suture material. In the other group (group B) of 100 cases, closure was done with the technique of simple interrupted sutures with Prolene No.1 suture material. Comparison of both the techniques regarding preoperative status and postoperative complication such as incisional hernia, wound dehiscence, suture sinus formation, stitch granuloma, and chronic wound pain was done according to clinical examination and recorded in the pro forma prepared. In group A, postoperative complications were incisional hernia 3 %, wound dehiscence 4 %, and suture sinus formation 1 %. In group B, postoperative complication were incisional hernia 5 %, wound dehiscence 4 %, and suture sinus formation 1 %. All these complications were statistically insignificant, in both group comparisons. While the complication such as stitch granuloma 3 %, chronic wound pain 3 %, and wound infection 4 % in group A was significantly less than in group B where the complication of stitch granuloma was 12 %, chronic wound pain 13 %, and wound infection 13 % (P value 0.03, P value 0.018, and P value 0.048, respectively). Both the techniques, simple interrupted suture closure and continuous with intermittent Aberdeen knot closure for midline laparotomy fascial wounds, show a similar rate of postoperative complication such as incisional hernia, wound dehiscence, and suture sinus formation. But the continuous suturing with intermittent Aberdeen knot technique is a better option to prevent complications such as stitch granuloma, chronic wound pain, and wound infection, which are higher in the simple interrupted fascial wound closure technique.     

节段设计原则在面部瘢痕外科治疗中的临床应用

目的 探讨节段设计原则在面部瘢痕治疗中的应用。方法 自2012年1月至2014年6月,对38例面部瘢痕患者,在修复面部瘢痕时,以面部张力线、组织器官活动分区,以及面部凹凸曲面为界,将瘢痕分解成多个节段瘢痕,对多节段瘢痕采用手术切除,常规美容外科技术分层减张缝合。于术后3~6个月手术切口愈合稳定后,将留存的节段间点状瘢痕行手术或点阵激光治疗。结果 术后随访1~3年,瘢痕质地、色泽较好,无明显瘢痕挛缩,无明显凹陷畸形。结论 针对面部线型瘢痕,根据面部皮肤张力线对其进行多节段分解,采用手术联合激光等综合手段,可以获得较好的美容效果。     

Continuous tension reduction technique in facial scar management: A comparison of W‐plasty and straight‐line closure on aesthetic effects in Asian patients

W‐plasty is a very popular scar excisional revision technique. The core of the technique is to break up the scar margins into small triangular components, so as to cause light scattering and make the scar less noticeable. However, due to skin tension, facial incision scars tend to spread. Applying W‐plasty alone cannot achieve the ideal repair effect of facial scars. In this study, we proposed a scar revision technique combined W‐plasty with continuous tension‐reduction (CTR) technique to improve the appearance of facial scars. Sixty patients with facial scar were comprised in this retrospective study. Scars were assessed independently using the scar scale before and at 12‐month follow‐up. Clinical results showed a significant difference in scar appearance between different groups at 12‐month follow‐up. Vancouver scar scale (VSS), visual analogue scale (VAS) scores, and patient satisfaction were significant better in W‐plasty and CTR than other groups at 12‐month follow‐up. No severe complications were reported. The application of the tension offloading device provides an environment where the tension is continuously reduced, which could greatly decrease tension on the surgical incision. Combined with W‐plasty, this technique could significantly improve the scar''s aesthetic appearance.     

Long-term follow-up of a randomized controlled trial of suture versus mesh repair of incisional hernia

OBJECTIVE: The objective of this study was to determine the best treatment of incisional hernia, taking into account recurrence, complications, discomfort, cosmetic result, and patient satisfaction. BACKGROUND: Long-term results of incisional hernia repair are lacking. Retrospective studies and the midterm results of this study indicate that mesh repair is superior to suture repair. However, many surgeons are still performing suture repair. METHODS: Between 1992 and 1998, a multicenter trial was performed, in which 181 eligible patients with a primary or first-time recurrent midline incisional hernia were randomly assigned to suture or mesh repair. In 2003, follow-up was updated. RESULTS: Median follow-up was 75 months for suture repair and 81 months for mesh repair patients. The 10-year cumulative rate of recurrence was 63% for suture repair and 32% for mesh repair (P < 0.001). Abdominal aneurysm (P = 0.01) and wound infection (P = 0.02) were identified as independent risk factors for recurrence. In patients with small incisional hernias, the recurrence rates were 67% after suture repair and 17% after mesh repair (P = 0.003). One hundred twenty-six patients completed long-term follow-up (median follow-up 98 months). In the mesh repair group, 17% suffered a complication, compared with 8% in the suture repair group (P = 0.17). Abdominal pain was more frequent in suture repair patients (P = 0.01), but there was no difference in scar pain, cosmetic result, and patient satisfaction. CONCLUSIONS: Mesh repair results in a lower recurrence rate and less abdominal pain and does not result in more complications than suture repair. Suture repair of incisional hernia should be abandoned.     

Loose fascial closure and fascial defects: effects on laparotomy healing in rats

Summary Every suture technique in surgery aims at connecting tissue structures until stable scar formation has developed. Although the negative effects of high suture tension on the mechanical properties of the developing scar are well known, the applied suture tension has not been standardized and depends on the surgeon's experience. In this study the effects of low suture tension on laparotomy closure were studied in rats and an incisional hernia model was developed. Median laparotomies were closed by running suture using Foley-catheters with a diameter of 2.4, 4.8 and 7.2 mm as distance holders. In another group, an abdominal wall defect of 2 cm diameter was created and covered internally by larger omentum. After 28 days laparotomies closed using a distance holder with diameter of 2.4 and 4.8 mm had healed without developing fascial dehiscence or incisional hernia. With 7.2 mm catheters all animals developed a ruptured abdomen. All animals with abdominal wall defects developed incisional hernias with stable hernial sacs without significant inflammatory reaction. Laparotomy closure intentionally performed with a surplus of suture material of up to 21% per stitch in a 4 cm incision does not result in a disturbance of wound healing or hernia formation. Creating an abdominal wall defect with an internal covering of great omentum in rats reliably results in incisional hernia formation closely resembling that found in humans. These results underline the necessity to further determine values for tissue-specific suture tension experimentally.