Running W Incision in Open Rhinoplasty: Better Scar Quality

Since 1997, 129 patients have undergone the open approach rhinoplasty procedure. Scar quality with running W incision was compared to the scar with V type incision. According to clinical and statistical evaluations after 6 months, postoperatively the running W incision group showed better scar quality than the V type incision group. The advantages of a running W incision are camouflaging the depressed scar in the incision line and decreasing the angles of the corners of incision lines. Running W type incision is superior to V incision on the columella and may provide less scaring than a single Z, and reverse V incisions according to our long-term clinical results.     

Closed Rhinoplasty with Marginal Incision: Our Experience and Results

Supporters of traditional rhinoplasty and promoters of open rhinoplasty have debated their approaches for many years. From among different possible techniques, a surgeon must always choose the approach that provides the best aesthetic result. The surgeon’s experience and artistic sense are essential for the closed technique, whereby most of the corrections are performed without exposing the nasal frame. The open technique allows a greater operating range with a direct view of the nasal structure, resulting in improved precision in modeling the cartilages. However, the absence of intact skin cover exposes the surgeon to a less precise overall aesthetic evaluation. This report highlights the marginal technique, described in 1990 by Guerrerosantos, which uses a two-sided circular incision permitting complete dissection of the alar cartilages and the overhead skin cover of the columella. This approach, together with the extramucous technique, permits complete exposure of the skin and nasal septum without a columella incision. Therefore, the marginal technique is suitable for primary rhinoplasty cases in which complex modeling of the nasal tip and an excellent aesthetic result are required.     

Open Rhinoplasty Through a Forked Flap Incision

Surgical elongation of the short columella is a challenging problem for the surgeon. Although some flaps from the upper lip are successfully used to correct this deformity on cleft lip patients with a scarred upper lip, these methods cannot be applied to noncleft patients with a smooth upper lip. Distant flaps and composite grafts do not give the best aesthetic results. The use of an external approach for rhinoplasty is preferred by many surgeons, especially for difficult or secondary cases. Most incisions for open rhinoplasty are placed on the columella. This report describes a new incision for open rhinoplasty to be used on patients with a short columella. The incision is a standard forked flap with a columellar base but the legs of the flap extend to the nostril bases instead of to the upper lip. This method was used on eight aesthetic rhinoplasty patients with a short columella between March 1995 and March 1998. The results of the method are discussed.     

Simultaneous Open Rhinoplasty and Alar Base Excision for Secondary Cases

Background: Simultaneous open rhinoplasty and alar base excision are a very safe procedure for protecting the vascular supply of the nasal dip and the columellar skin in primary cases when surgical dissection is performed below the musculoaponeurotic layer of the nose. Major arteries of the external nose lie above the musculoaponeurotic layer. However, secondary cases may pose increased risks to the blood supply of the nasal tip and columella skin because of the decreased vascular supply and increased scar tissue from the previous rhinoplasty. We studied our secondary cases of simultaneous open rhinoplasty and alar base excision, to assess the real risk for necrosis of the nasal tip and columellar skin.Methods: A total of 12 secondary patients (6 men and 6 women) underwent simultaneous open rhinoplasty and alar base excision in the past 3 years. Their average age was 27 years (range, 21–35 years). The average follow-up period was 15 months (range, 1–35 moths). A modified grading system, originally described by Bafaqeeh and Al-Qattan, was used for assessment of the blood supply in the nasal tip and the columellar skin.Results: Satisfactory results were obtained for our patients, with the exception of one case. Grade 3 vascular compromise to the nasal tip and the columella was observed in one case, but the patient healed well with wound care treatment.Conclusion: Simultaneous alar base excision and open rhinoplasty can be performed safely in secondary cases. However some surgical maneuvers such as subcutaneous pocket preparation for the tip graft in closed rhinoplasty and subdermal defatting in the first rhinoplasty as well as previous scarring on the nasal lobule can disrupt the vascular supply of the nasal tip and columella skin. Under these conditions, alar base excision should be deferred and then performed as an isolated excision procedure.     

External Rhinoplasty for the Arabian Nose: A Columellar Scar Analysis

This study aimed to evaluate columellar scar problems after external rhinoplasty in the Arabian population, and to analyze the technical factors that help prevent such problems and maximize the scar cosmesis. The investigation was conducted in university and private practice settings of the author in Alexandria, Egypt. A total of 600 Arab patients who underwent external rhinoplasty were included in the study. All the patients underwent surgery using the external rhinoplasty approach, in which bilateral alar marginal incisions were connected by an inverted V-shaped transcolumellar incision. At completion of the procedure, a two-layer closure of the columellar incision was performed.At a minimum of 1 year postoperatively, the columellar scar was evaluated subjectively by means of a patient questionnaire, and objectively by clinical examination and comparison of the close-up pre- and postoperative basal view photographs. Objectively, anything less than a barely visible, leveled, thin, linear scar was considered unsatisfactory. Subjectively, 95.5% of the patients rated the scar as unnoticeable, 3% as noticeable but acceptable, and 1.5% as unacceptable. Objectively, the scar was unsatisfactory in 7% of the cases. This was because of scar widening with or without depression (5%), hyperpigmentation (1.5%), and columellar rim notching (0.5%). The use of a deep 6/0 polydioxanon (PDS) suture significantly decreased the incidence of scar widening (p < 0.005).The columellar incision can be used safely in the Arab population regardless of their thick, dark, and oily skin. Technical factors that contributed to the favorable outcome of the columellar scar included proper planning of location and design of the incision used, precise execution, meticulous multilayered closure, and good postoperative care.     

A Surgical Algorithm Using Open Rhinoplasty for Correction of Traumatic Twisted Nose

In this series, the authors present their experience with correction of the traumatic twisted nose in Asians using open rhinoplasty. A standard surgical algorithm was followed to determine treatment strategies for 92 patients with traumatic twisted nose at the Tri-Service General Hospital in Taiwan between 1 August 2001 and 1 June 2004. A retrospective chart review was performed to collect patient data and surgical details. A follow-up self-evaluation survey regarding satisfaction with nasal function and aesthetics was distributed to all the participants. All the patients underwent open rhinoplasties under general anesthesia. The 87 males and 5 females were 15 to 53 years of age (mean, 28 years). Their postoperative periods were uneventful and without complications. Patient self-evaluations were largely positive, reporting improvement in nasal function. The authors propose a simple surgical algorithm using open rhinoplasty for optimal correction of traumatic twisted nose deformities. The algorithm, which is adaptable to a variety of anatomic deformities, guides surgical decision making that yields consistently satisfactory functional and aesthetic results.     

直切口与横S形切口对髌骨骨折患者术后瘢痕形成及关节功能的影响比较

目的 比较直切口与横S形切口治疗对髌骨骨折术后瘢痕形成及关节功能的影响。方法 选取 2022年4月-2023年4月我院诊治的70例髌骨骨折患者为研究对象,采用随机数字表法分为对照组和观察 组,各组35例。对照组采用横形切口治疗,观察组采用直切口治疗,比较两组临床手术指标、并发症发 生率、瘢痕VSS评分、关节功能Bostman评分。结果 观察组切口长度小于对照组,术中出血量少于对照 组,骨折愈合时间短于对照组（P ＜0.05）,而两组手术时间比较,差异无统计学意义（P ＞0.05）;观察 组并发症发生率（8.57%）低于对照组（20.00%）（P ＜0.05）;观察组治疗后12周瘢痕各维度（血管分 布、柔软度、色泽、厚度）评分均低于对照组（P ＜0.05）;观察组治疗后12、24周Bostman评分均高于对 照组（P＜0.05）。结论 与横S形切口比较,直切口治疗髌骨骨折具有切口小、术中出血量少、利于骨折愈 合、术后瘢痕形成小、关节功能恢复佳的优势。但横S形切口显露相对较好,临床可依据患者髌骨骨折具 体情况进行合理选择。     

Improving Nasal Tip Projection and Definition Using Interdomal Sutures and Open Approach Without Transcolumellar Incision

The object of this study was to maximally take advantage of the combination of two surgical techniques to manage the nasal tip. For this, an approach similar to the open tip approach without a transcolumellar incision was performed and the management of the alar cartilages with multiple combined sutures was carried out. This study represents more than two years of work where 57 primary and secondary rhinoplasty patients were operated on. In all of them, the nasal tip was managed by means of utilizing different types of sutures in the alar cartilages, according to the characteristics and needs of each patient. At the same time, an extensive lipectomy was performed on the nasal tip, if indicated. All of the nasal tip surgeries were performed with an open approach without transcolumellar incision. This approach has been previously described, is highly simple, and it eliminates the principal disadvantage of a transcolumellar scar that arises from the open approach technique. Although the scar is hardly noticeable in Caucasian patients, in non-Caucasians it could constitute an important undesirable effect. This approach permits us to manage the cartilages using sutures in many diverse types and variations in a more complete form, similar to which one could achieve using the classical open approach technique. The results are highly satisfactory and result in a definition and rotation of the nasal tip which would be difficult using the closed technique. Therefore, this study represents another alternative surgical technique in the surgical management of the nasal tip.     

Zigzag Skin Incision Effectively Camouflages the Scar and Alopecia for Moyamoya Disease: Technical Note

Moyamoya disease is commonly diagnosed in children, and requires various vascular reconstruction to improve symptoms. Therefore, scar widening and hair loss after craniotomy, which sometimes occurs in this disease, are serious problems for patients. A variety of plastic surgical techniques in scalp have been reported to minimize the scar widening and hair loss. However, any neurosurgical reports describing this purpose have never been published for moyamoya disease. The objective of this study was to investigate whether these plastic surgical techniques could be applied to bypass surgery without any compromise of vascular reconstruction for moyamoya disease. We performed direct and indirect vascular reconstruction in six hemispheres of moyamoya disease patients not only in the middle cerebral artery territory but also in the anterior cerebral artery territory. The scalp incision was designed not parallel to the hair stream, and the bevelled incision was conducted not to jeopardize the hair follicles. The scar and hair loss were effectively camouflaged throughout the postoperative period in all cases. This study demonstrates that our design of scalp incision achieve effective vascular reconstruction and obscure the scar and hair loss.     

The Round-Ear Incision in Full Face-Lifting

Several techniques for face-lifting have been described, all aimed at achieving a youthful appearance with a hidden scar. The authors are concerned about the conspicuous horizontal scar that travels all the way through the hairless skin behind the ears, which they consider very unpleasant and totally unnecessary. They are able to achieve a normal-appearing face with a safer technique that minimizes the visible scars such as the postauricular one, yet still has good and lasting results. In the past 9 years, 202 patients, men and women ages 38 to 86 years, have undergone surgery using the round-ear face-lifting technique, most of them with local anesthesia and sedation. The authors were able to achieve good and lasting results with a minimum of complications and to change the unaesthetic postauricular scar to a retroauricular one (with contouring of the concha) using a new design of marking the skin incisions. A new face-lifting incision is described. The procedure is suitable and safer for all patients requiring facial rejuvenation. The main advantage of this technique is the absence of visible postauricular scars. Paper presented at the 17th Congress of the International Society of Aesthetic Plastic Surgery (ISAPS), Houston, USA, 2004, and at the 18th Congress of the International Society of Aesthetic Plastic Surgery (ISAPS), Rio de Janeiro, Brazil, 2006.     

Turn-in Folding of the Cephalic Portion of the Lateral Crus to Support the Alar Rim in Rhinoplasty

Backgrounds The hypoplastic, weak lateral crus of the nose may cause concave alar rim deformity, and in severe cases, even alar rim collapse. These deformities may lead to both aesthetic disfigurement and functional impairment of the nose. Methods The cephalic part of the lateral crus was folded and fixed to reinforce the lateral crus. The study included 17 women and 15 men with a median age of 24 years. The average follow-up period was 12 months. For 23 patients, the described technique was used to treat concave alar rim deformity, whereas for 5 patients, who had thick and sebaceous skin, it was used to prevent weakness of the alar rim. The remaining 4 patients underwent surgery for correction of a collapsed alar valve. Results Satisfactory results were achieved without any complications. Conclusions Turn-in folding of the cephalic portion of lateral crus not only functionally supports the lateral crus, but also provides aesthetic improvement of the nasal tip as successfully as cephalic excision of the lateral crura.     

冠心病经股动脉穿刺部位监测与表皮切口瘢痕的管理与教学方法

目的 探究冠心病经股动脉穿刺部位监测与表皮切口瘢痕的管理与教学方法。方法 选取2022年6月-7月我院心外科8名临床医生为培训对象,进行冠心病经股动脉穿刺部位监测与表皮切口瘢痕的管理培训,并选取同期行经股动脉穿刺治疗的23例冠心病患者为观察组,选取2022年4月-5月行经股动脉穿刺治疗的23例冠心病患者为对照组,比较两组穿刺点出血发生率、表皮切口并发症发生率、表皮切口瘢痕形成情况、表皮皮肤损伤程度及满意度。结果 观察组穿刺点出血发生率为4.35%,低于对照组的17.39%（P＜0.05）;观察组表皮切口并发症发生率为8.70%,低于对照组的21.74%（P＜0.05）;观察组表皮切口瘢痕厚度、长度及宽度均小于对照组（P＜0.05）;观察组表皮皮肤正常、Ⅰ度损伤占比均高于对照组,Ⅱ度损伤占比低于对照组（P＜0.05）;观察组满意度为95.65%,高于对照组的82.61%（P＜0.05）。结论 冠心病经股动脉穿刺部位监测与表皮切口瘢痕的管理与教学方法具有良好的效果,可降低穿刺点出血率、表皮切口并发症发生率,减少对表皮皮肤的损伤,改善表皮切口瘢痕厚度、长度及宽度,有利于提高患者满意度。     

改良眶隔法和传统睑板法切开重睑术的术后重睑形态、瘢痕发生率、角膜暴露率比较研究

目的 比较改良眶隔法和传统睑板法切开重睑术中的应用效果及对术后重睑形态、瘢痕发生率、角膜暴露率的影响。方法 选取2020年3月-2021年3月首都医疗爱育华医院收治的80例单睑患者,采用随机数字表法将其分对照组和观察组,各40例。对照组接受传统睑板法切开重睑术,观察组接受改良眶隔法切开重睑术,比较两组术后重睑形态、瘢痕发生率、角膜暴露率、并发症发生率。结果 观察组总有效率高于对照组,差异有统计学意义（P＜0.05）;观察组GAIS评分高于对照组,VAS评分低于对照组,差异有统计学意义（P＜0.05）;观察组右侧角膜暴露率增加值、左侧角膜暴露率增加值高于对照组,差异有统计学意义（P＜0.05）;观察组并发症发生率为5.00%,低于对照组的22.50%,差异有统计学意义（P＜0.05）。结论 相比于传统睑板法切开重睑术,改良眶隔法切开重睑术不会过度增加术后角膜暴露率,术后瘢痕发生率更低,重睑形态更理想,患者接受度更高。     

梭形横切口在保乳手术中的应用

目的探讨梭形横切口在保乳手术中的应用效果。方法2003年11月~2006年9月对25例乳腺癌患者采用梭形横切口行保乳手术,其中全麻9例,局麻16例。术毕创口置小号引流管,间断缝合残腔,用Prolene线皮下连续埋线法缝合切口。结果术后未发生切口感染、皮下积液及皮肤坏死等并发症,平均7 d出院。随访1~34月,所有病例乳房形态保持良好,患者满意。无一例肿瘤复发。结论梭形横切口为保乳手术提供了一种较好的切口方式。     

非吸收材料与吸收材料注射隆鼻后的塑形效果比较

目的 比较非吸收材料与吸收材料注射隆鼻后的塑形效果。方法 选取2019年10月-2022年10月于我院行隆鼻术的85例患者为研究对象,以随机数字表法分为对照组（n =42）与研究组（n =43）。对照组给予吸收材料瑞兰注射,研究组给予非吸收材料爱贝芙注射,术后随访6个月,比较两组塑形效果、鼻外观改变情况、美学达标率、不良反应发生率及满意度。结果 研究组术后6个月隆鼻后综合评分高于对照组（P ＜0.05）;研究组术后6个月鼻尖角、鼻尖高度及鼻长均优于对照组（P ＜0 . 0 5）;研究组鼻额角、鼻面角、鼻尖突出度及鼻唇角的美学达标率均高于对照组（P＜0.05）;研究组不良反应发生率为4.65%,低于对照组的21.43%（P＜0.05）;研究组满意度为95.35%,高于对照组的78.57%（P ＜0.05）。结论 非吸收材料注射隆鼻后的塑形效果及美学效果均优于吸收材料,能够有效改善鼻外观,且不良反应较少,患者满意度较高。     

皮下美容缝合技术在剖宫产术后切口处理中的应用效果

目的:探究皮下美容缝合技术在剖宫产术后切口处理中的应用。方法:笔者医院2017年1月-2019年4月收治的152例产妇,按照随机数表法分为观察组与对照组,各76例。对照组采用常规缝合技术,观察组采用皮下美容缝合技术。比较两组治疗效果、手术相关指标、术后疼痛视觉模拟评分(Visual analogue scale,VAS)、不良反应发生率及切口愈合等级。结果:观察组总有效率为96.05%,对照组为80.26%,差异有统计学意义(P<0.05)。观察组切口缝合时间、手术时间显著短于对照组,差异有统计学意义(P<0.05);两组切口长度比较,差异无统计学意义(P>0.05)。两组术后7d、30d两组VAS评分呈下降趋势,观察组相同时间点均低于对照组(P<0.05)。观察组切口瘢痕增生率、瘢痕宽度、瘢痕最薄厚度均低于对照组,差异有统计学意义(P<0.05)。观察组与对照组不良反应发生率分别为3.95%、15.79%,差异有统计学意义(P<0.05)。观察组切口愈合甲级为97.37%,而对照组为93.42%,但组间比较差异无统计学意义(P>0.05)。结论:皮下美容缝合技术用于剖宫产可有效提高切口愈合质量,显著改善瘢痕形成和术后疼痛,减少并发症发生,值得推广应用。     

综合护理干预对剖宫产后切口愈合及瘢痕形成的影响

目的:探讨综合护理干预对促进剖宫产术后切口愈合及防止瘢痕形成的影响。方法:选取2017年11月-2019年2月笔者医院收治的100例接受剖宫产手术的孕产妇,随机分成两组,对照组在术后给予常规护理,观察组术后进行综合护理干预。对两组患者的切口缝线反应、切口愈合效果、瘢痕形成情况进行比较。结果:观察组0度缝线反应率为94.0%明显高于对照组的80.0%;观察组切口愈合总有效率为96.0%,高于对照组的86.0%;观察组护理干预后瘢痕增生率为4.0%,低于对照组的12.0%,其瘢痕厚度、宽度也均小于对照组;差异均有统计学意义(P<0.05)。结论:综合护理干预对剖宫产手术切口愈合有良好效果,且有利于降低瘢痕形成。     

Dermabond皮肤粘合剂对外科手术切口愈合效果及美观度的影响

目的:探讨Dermabond皮肤粘合剂对外科手术切口的愈合效果,为临床外科手术切口愈合提供参考。方法:选取2017年8月-2018年8月接诊的外科手术患者80例。按自愿原则照随机数表法分为观察组(46例)与对照组(34例)。对照组患者手术切口采用传统缝线缝合,观察组患者手术切口采用Dermabond皮肤粘合剂缝合。比较两组术后基本情况、切口愈合效果及切口美观满意度。结果:观察组切口闭合时间、术后8d切口护理费用明显少于对照组,观察组皮肤红肿、术后3d伤口疼痛、瘢痕形成发生率均明显低于对照组,差异有统计学意义(P<0.05)。观察组愈合质量明显优于对照组,切口美观满意度明显高于对照组,差异有统计学意义(P<0.05)。结论:Dermabond皮肤粘合剂用于外科手术切口闭合效果良好,能有效缩短切口闭合时间,降低并发症及瘢痕形成发生率,值得广泛应用。