微小切口导针埋线的额颞部除皱术

目的：避免传统面部除皱术所产生的头皮瘢痕，脱发，创伤较大，恢复时间长等不良反应。方法：对68例额颞部皮肤皱纹的求术者采用发际内微小切口入路，额颞部皮下潜行分离，将松垂的皮肤及筋膜上移，提紧，舒展皱纹，切除或切断形成皱纹的肌肉。其中单纯导针埋线颞部提紧除皱术11例，经微小切口入路颞部提紧除皱术25例。额颞部提紧除皱术32例。结果：随访6个月至2年，效果满意，头皮瘢痕不明显，无脱发等并发症。结论：导针埋线法额颞部除皱术，操作简单，可在门诊进行；创伤较轻，恢复较快，切口微小，瘢痕轻微。     

内窥镜在额颞部除皱术中的应用

目的：探讨内窥镜下额颞部除皱术的临床应用效果。方法：对接受内窥镜下额颞部除皱术的36例患者,采用额颞部发际内小切口,在内窥镜下通过去除部分眼轮匝肌、皱眉肌、降眉肌、额肌等去除额颞部皱纹;在帽状腱膜下和颞深筋膜浅层剥离,颞部用丝线固定于颞深筋膜上。结果：与传统大切口除皱相比内窥镜下去除额颞部皱纹效果确切,提升效果好,术后会有额部麻木感,但一般在3～6个月后恢复,手术无明显瘢痕,无脱发,就医者满意率达100%。大切口除皱可见瘢痕、脱发等并发症。瘢痕相比P〈0.05、脱发相比P〈0.05,有统计学意义。结论：内窥镜下额颞部除皱效果好、创伤小、恢复快。     

组织扩张器在额部皮瓣鼻再造术中应用探讨——临床报道10例

目的 减少扩张后的额部皮瓣再造鼻引起的严重继发挛缩，探讨组织扩张器在额部皮瓣鼻再造术中的应用。方法 对发际高的患者直接采用额部皮瓣行鼻再造，额部供区植皮，同期额额部署入扩张器，Ⅱ期修复额部植皮区瘢痕。结果 共治疗了10例患者，术后鼻外形良好，并对其进行随访，最长3年，效果满意。结论 该方法证实具有远期鼻挛缩较少，额部瘢痕不明显等优点，临床效果良好。     

小切口额部发际塑形术

前额发际过低，让人感觉额部不够饱满，精神不振，影响面部美观。目前，常用方法有激光、电解毛囊、手术切除法。但脱毛效果不够理想，治疗时间较长，费用较高，且术后瘢痕较明显。为达到永久且无瘢痕去除额部低发际，我们自2000年12月，开展小切口额部发际塑形术16例，均取得了满意的效果，现报道如下。     

额部扩张皮瓣在修复瘢痕性眼睑外翻中的应用

目的：探讨额部扩张皮瓣修复瘢痕性眼睑外翻的方法.方法：2006年8月～2012年4月间,笔者单位收治的13例瘢痕性眼睑外翻患者,采用额部扩张皮瓣修复,男8例,女5例,年龄17～58岁,平均36岁,病程6月～21年,其中上睑5例,下睑8例；眼睑外翻Ⅱ 度6例,Ⅲ 度7例.瘢痕挛缩致眼睑软组织缺损范围10mm × 30mm～ 45mm×50mm.手术Ⅰ期在额部埋置50～ 150ml皮肤软组织扩张器,Ⅱ 期转移扩张皮瓣至睑外翻患处,Ⅲ 期,3周后断蒂.结果：13例患者额部扩张皮瓣均成活,眼睑形态良好,睑外翻矫正,眼睑闭合自如.随访6个月～1年无睑外翻复发.结论：额部扩张皮瓣能够有效修复瘢痕性眼睑外翻.     

头皮分层切开和帽状腱膜覆盖减张缝合法预防额颞部除皱术后脱发

目的：探讨额颞部除皱术治疗额颞部皮肤老化的缝合方法及临床效果。方法：设计头皮分层切开和帽状腱膜覆盖减张缝合法，头皮的皮肤和皮下组织与帽状腱膜的切开不在同一水平，将形成的后叶帽状腱膜瓣和前叶帽状腱膜深面减张缝合。结果：在过去的5年中，此缝合方法应用于56例额颞部或全颜面除皱术。术后随访证实此缝合方法能长时间地去除额纹，上提眉毛，并可预防术后出现永久性脱发和凹陷性瘢痕。结论：头皮分层切开和帽状腱膜覆盖减张缝合法能有效地维持手术效果，并预防术后出现脱发和凹陷性瘢痕。     

小切口额颞部除皱术

为了减轻损伤程度，在按传统方法做了大量额颞部除皱手术的基础上，参考了内窥镜除皱手术的一些原理和方法，于１９９４年开展了盲视下小切口额颞部除皱术。为此，设计了专用的手术分离器和齿状切割刀。整个手术只需在额部正中及颞部发际内作３处不足１ｃｍ长的纵行切口，额部及顶部在帽状腱膜下进行分离，至两侧颞线改在颞部皮下颞浅筋膜浅面分离。用齿状切割刀切断部分额肌和帽状腱膜及皱眉肌、降眉肌，沿冠状缝切断部分帽状腱膜。舒平额颞部皮肤皱纹，将多余的头皮向上后推向头顶部，切实加压包扎。用此方法做额颞部除皱１０６例，取得了满意的效果。突出的优点是损伤少、瘢痕小、快速。作者详细总结了该方法的手术操作、体会和注意事项。     

额部扩张皮瓣的手术设计

目的 探讨额部扩张皮瓣的手术设计。方法 对121例额、颞部瘢痕、斑痣、血管瘤等皮肤病变切除后的患者采用额部扩张皮瓣进行修复，并比较滑行皮瓣、易位皮瓣及旋转皮瓣的手术效果。结果 115例患者取得良好的手术效果，修复后皮肤弹性良好、颜色较理想、瘢痕较细小；4例患者扩张皮瓣的远端有0．5～1．0cm的坏死，行Ⅱ期瘢痕切除缝合术；2例患者有单侧眉上提，半年后好转。结论 易位皮瓣术后瘢痕明显，尽量少用或不用；旋转皮瓣可以充分利用扩张后“过剩”的皮肤。是一种值得推广的额部皮瓣设计方法。对皮瓣的周密设计并了解不同皮瓣的优缺点。对手术效果及术后并发症的预防非常重要。     

组织扩张器在额部皮瓣鼻再造术中应用探讨——临床报道10例

目的　减少扩张后的额部皮瓣再造鼻引起的严重继发挛缩 ,探讨组织扩张器在额部皮瓣鼻再造术中的应用。方法　对发际高的患者直接采用额部皮瓣行鼻再造 ,额部供区植皮 ,同期额部置入扩张器 ,Ⅱ期修复额部植皮区瘢痕。结果　共治疗了 1 0例患者 ,术后鼻外形良好 ,并对其进行随访 ,最长 3年 ,效果满意。结论　该方法证实具有远期鼻挛缩较少、额部瘢痕不明显等优点 ,临床效果良好     

组织扩张器在额部皮瓣鼻再造术中应用探讨——临床报道10例

目的减少扩张后的额部皮瓣再造鼻引起的严重继发挛缩,探讨组织扩张器在额部皮瓣鼻再造术中的应用.方法对发际高的患者直接采用额部皮瓣行鼻再造,额部供区植皮,同期额部置入扩张器,Ⅱ期修复额部植皮区瘢痕.结果共治疗了10例患者,术后鼻外形良好,并对其进行随访,最长3年,效果满意.结论该方法证实具有远期鼻挛缩较少、额部瘢痕不明显等优点,临床效果良好.     

导针埋线法额颞部提紧术

目的　为了避免传统的面部提紧术所产生的头皮瘢痕、脱发、创伤大、恢复时间长等难以避免的不良反应。方法　采用发际内微小切口入路行额颞部潜行分离 ,将松垂的皮肤及筋膜上移、提紧 ,舒展皱纹 ,切除或破坏形成皱纹的肌肉。结果　临床应用 71例 ,其中单纯导针埋线法颞部提紧术 18例 ,微小切口入路颞部提紧术 2 6例 ,额颞部提紧术 2 7例。经随访 ,效果满意 ,未出现头皮瘢痕、脱发等并发症。结论　导针埋线法额颞部提紧术具有操作简单、创伤较轻、恢复较快、切口微小、术后不留或少留手术瘢痕、面部除皱效果确切等优点 ,且可在门诊进行     

骨膜下径路前额脂肪瘤切除术

目的：为了充分认识前额脂肪瘤的特征,并使术后得到最佳美学效果。方法：发际切口,带照明直接喉镜辅助,明视骨膜下径路切除门例前额脂肪瘤。结果：前额脂肪瘤位于额肌和骨膜之间;术后效果满意,随访2年-3年,无一例复发。结论：前额脂肪瘤属异位脂肪瘤,该方法无可见性瘢痕,易掌握分离层次,尤其适合于有瘢痕素质的患者。     

Forehead Donor Site Full-Thickness Skin Graft

BACKGROUND: Full-thickness skin grafts (FTSGs) are useful for reconstructing nasal defects. Traditional reported donor sites include the preauricular, postauricular, supraclavicular, clavicular, conchal bowl, melolabial fold, and upper eyelid skin. Selection of the "best" donor site is based on the "best" tissue match and ability to camouflage the donor scar. OBJECTIVE: The purpose was to report our experience with FTSGs harvested from the forehead for reconstruction of nasal defects following Mohs' surgery. METHODS: A retrospective query of the Mohs' surgery database was performed to identify nasal defects repaired with a FTSG harvested from the forehead skin. The research record contained the patient age and gender, defect size, and cosmetic and functional outcomes interpreted by the patient and surgeon. RESULTS: FTSGs from forehead skin were used to repair the nasal defects in three patients. The functional and cosmetic outcome of all three cases was deemed excellent by the patient and surgeon. Donor site scars were well concealed within preexisting rhytids. CONCLUSION: FTSGs harvested from the forehead, although limited in practical utility, may offer an optimal FTSG match for limited select defects while also providing an easily camouflaged donor site scar within a forehead rhytid.     

The development of a new tissue expander for use in ophthalmic plastic surgery

We describe the first-time use of the tissue expansion principle in oculoplastic surgery. We have designed a tissue expander for use in eyelid surgery. This instrument was successfully used to treat difficult cases of cicatricial ectropion from multiple causes, avoiding the need for tissue grafting. It was also utilized preoperatively so a large forehead scar could be removed with good resultant cosmesis. The potential for this device in oculoplastic surgery is exciting.     

Exposed artificial bone in the forehead covered with a transverse orbicularis oculi myocutaneous flap

We have reconstructed the forehead by covering exposed artificial bone with a transverse orbicularis oculi myocutaneous flap. This technique had the following advantages: good circulation in the flap extended the arc of rotation; the flap matched the forehead in colour and texture; the scar of the flap donor site was not conspicuous, and no dysfunction was seen; and the technique is simple and not invasive.     

Exposed artificial bone in the forehead covered with a transverse orbicularis oculi myocutaneous flap.

We have reconstructed the forehead by covering exposed artificial bone with a transverse orbicularis oculi myocutaneous flap. This technique had the following advantages: good circulation in the flap extended the arc of rotation; the flap matched the forehead in colour and texture; the scar of the flap donor site was not conspicuous, and no dysfunction was seen; and the technique is simple and not invasive.     

5 mm微切口单孔腹腔镜全子宫切除术初探

目的初步探讨5 mm微切口单孔腹腔镜全子宫切除术的安全性与可行性。 方法回顾性分析1例接受5 mm微切口单孔腹腔镜全子宫切除术患者的临床资料并进行总结分析。患者为52岁女性,因发现宫腔占位入院,诊刮术后病理提示为子宫内膜复杂性增生过长伴不典型增生,行5 mm微切口单孔腹腔镜全子宫切除术。 结果手术成功完成,手术总时间155 min,术中未增加其他通道,无中转开腹,术中出血量约50 ml。患者术后1 d即恢复肠蠕动,术后2 d拔除尿管后即恢复排尿功能。脐部切口为Ⅱ/甲愈合,无明显瘢痕。术后病理提示子宫内膜复杂性增生。患者恢复情况良好,对治疗效果十分满意。 结论在严格把握手术适应证的前提下,5 mm微切口单孔腹腔镜全子宫切除手术应用于部分条件适合的患者可能是安全可行的。     

小切口和皮下减张缝合技术在皮肤软组织扩张器置入术中的应用

目的：介绍小切口和皮下减张缝合技术在皮肤软组织扩张器置入术中的应用,以探寻更符合美学要求的软组织扩张整形美容技术。方法：根据瘢痕类型选用不同型号及形状的可控型扩张器,在局部肿胀麻醉下,经1.0～2.0cm小切口埋置扩张器。冷光源照射下,直视止血,切口皮下做减张缝合,术中注水10%～100%,切口7～10天拆线。结果：236例患者,507个扩张部位手术均获得成功。术后切口裂开3例（0.6%）,发生血肿11例（2.2%）,平均埋置一个扩张器的时间为45min,平均注水时间12周。手术时间和注水时间比常规方法缩短。结论：扩张器置入手术时应用小切口和皮下减张缝合技术具有损伤小,并发症发生率低,手术时间及注水时间缩短等优点,值得推广。     

The Youthful Forehead: Placement of Skin Incisions in Hidden Furrows

BACKGROUND: Attaining good aesthetic results remains a primary goal in removal of benign cutaneous facial lesions. OBJECTIVE: Strategic planning of the incision is perhaps the most critical step in excision of such a lesion. METHODS: A study of one case of epidermoid cyst excision from a youthful forehead was undertaken. RESULTS: Poor surgical planning of a simple cyst excision from the forehead resulted in placement of the incision inferior to a natural furrow and within the basin defect, producing a noticeable scar. Facial animation accentuates the aesthetically poor placement of the surgical incision. CONCLUSION: The detection of hidden furrows through facial animation during preoperative planning, especially in the youthful forehead, is imperative for achievement of an optimal aesthetic result. When possible, incisions should be concealed within natural furrows.