手术前备皮去毛方法与术后切口感染

从备皮方式对术后切口感染率的影响方面,总结术前剃毛备皮、剪毛备皮和脱毛备皮的特点与不足,提出为减少术后切口感染,最好采用不去毛或剪毛方式备皮,任何一种备皮方法都应注重皮肤的清洁.     

术前2h切口局部不剃毛备皮在骨科四肢手术中的应用

目的探讨术前2h切口局部不剃毛备皮在四肢手术应用的效果。方法选择骨科四肢手术患者80例,分为对照组和观察组各40例,对照组采用骨科常规备皮方法,观察组采用术前2h切口局部不剃毛备皮方法,比较护士用于备皮的时间、患者舒适度、皮肤消毒前后手术切口附近皮肤细菌数、手术切口感染率。结果两组护士用于备皮的时间、患者舒适度、皮肤消毒前手术切口附近皮肤细菌数等比较差异有统计学意义（均P〈0.05）,手术切口感染率差异无统计学意义（P〉0.05）。结论术前2h切口局部不剃毛备皮在骨科四肢手术可减轻护士的工作量、提高患者舒适度、减少备皮局部的细菌数。     

手术前备皮去毛方法与术后切口感染

从备皮方式对术后切口感染率的影响方面，总结术前剃毛备皮、剪毛备皮和脱毛备皮的特点与不足，提出为减少术后切口感染，最好采用不去毛或剪毛方式备皮．任何一种备皮方法都应注重皮肤的清洁。     

术前皮肤准备方法及卫生经济学分析

从备皮方式对术后切口感染率的影响方面,总结术前剃毛备皮、剪毛备皮、脱毛剂备皮及不除毛备皮的优点及不足,综述各种备皮方法的经济学分析情况,并介绍了国内外备皮方法的应用现状,指出剪毛和脱毛剂备皮法导致的切口感染发生率更低;从长远效益来看,脱毛剂备皮及剪毛备皮的成本要低于剃毛备皮法。     

两种备皮方法对大鼠大腿骨折模型手术内固定感染率影响的实验研究

<正>我国护理常规要求对手术患者于术前晚术区备皮,而临床多采用剃毛备皮的方法。美国疾病预防与控制中心(CDC)在1999年发布的《预防手术切口     

不同备皮方法对骨科I类切口感染率的影响

目的:探计两种不同的备皮方法对于骨科I类切口感染率的影响.方法:择期骨科手术患者600例,随机分为传统备皮组(A组)和改良备皮组(B组).分析比较两组患者术后切口感染率.结果:A组患者300例,切口感染率1.67%;B组患者300例,切口感染率1.33%.比较两组患者切口感染率无显著性差异(P>0.05).结论:传统剔除毛发备皮方法与不剃毛改良备皮法相比没有降低切口感染率,可以摒弃.     

骨科髋部手术备皮方法的改进研究

外科择期手术前1～3天进行剃毛备皮是我国历年来的护理常规之一，传统的备皮法操作次数多．累及会阴，涉及病人的隐私，同时髋部术野皮肤消毒后包扎操作繁琐复杂，胶布粘贴容易出现皮肤过敏，且剃毛备皮增加了损伤术野皮肤的机会，不利于手术进行。为此，本院骨科从2005年3月起采用改良的术前备皮法，收到较好的临床效果，现介绍如下。     

竖直切口内上蒂巨乳缩小术的临床应用

目的 根据巨乳缩小术的手术原则,探讨一种既能保证乳房血供和功能,又能保持良好乳房外观的手术方式,并观察其临床疗效.方法 本组共10例乳房肥大症患者,采用竖直切口结合内上蒂法行乳房缩小术.根据术前设计,去除内上蒂表皮,形成腺体蒂,再切除外下象限多余的皮肤及腺体,重塑乳房形态.结果 术后无皮肤坏死、脂肪液化、乳头乳晕感觉减退、血肿和感染等并发症发生,切口均Ⅰ期愈合.术后随访3～12个月,患者对术后乳房外观形态及功能均表示满意,能接受术后瘢痕.结论 竖直切口内上蒂巨乳缩小术操作简单、安全,对轻、中度,特别是中度乳房肥大患者特别适用,术后和远期均能达到满意疗效.     

神经外科锁孔手术两种备皮方法的对比观察

选择神经外科锁孔手术病人80例，随机分为观察组和对照组各40例，观察组采用术日剃除切口周围约3cm范围头发，对照组常规于术前1d剃除病人全部头发。结果观察组病人头皮损伤、备皮所需时间、疼痛不适感及负性心理发生率均显著低于对照组(均P＜0．01)；术后两组颅内感染率差异无显著性意义(P＞0．05)，两组病人均未发生切口感染。提示神经外科锁孔手术术日局部小范围剃毛备皮法优于开颅手术的常规备皮法。     

双环形切口乳房缩小整形术患者围术期护理

对75例乳房肥大患者实施双环形切口乳房缩小整形术,结果75例患者除7例术后出现并发症外,其余均切口愈合良好,乳房形态满意,远期乳头乳晕感觉良好,患者对整形效果满意.提出术前做好心理护理,局部皮肤准备,测量体重、乳房各项数值;术后重点针对吸收热、引流、疼痛、心理特点等做好观察、护理,并做好体位指导、并发症护理及出院指导,可保证手术效果.     

双环中央蒂乳房缩小成形术的加网或外侧附加切口技术并发症的特点和适应证

目的 比较双环中央蒂乳房缩小成形术中加网和外侧附加切口的并发症，分析其产生的原因，以避免或减少并发症的发生。方法 回顾2003年8月至2006年5月收治的58例乳房缩小成形术，比较两种方法发生的并发症，包括：感染、血肿、脂肪液化、乳头乳晕血运障碍、皮肤坏死、切口愈合不良、切口瘢痕明显、网片折叠、双侧乳房不对称、缩小程度不足等。结果 加网组19例，发生并发症者6例，其中4例早期并发症患者平均切除腺体重276g；无网也无外侧附加切口3例，无并发症。附加切口组36例，发生并发症者7例（19．4％），其中5例早期并发症患者平均切除腺体重1008g。结论 加网组的并发症主要与网片有关，而附加切口组的并发症与乳房过大、切除腺体多、影响保留的腺体血供有关，改进网片材质和编织工艺、调整网片张力、避免用于表面皮肤过薄的患者，可以减少加网组的并发症。巨大乳房不宜选用双环中央蒂乳房缩小成形术的附加切口法或双环法。     

Vertical scar versus the inverted-T scar reduction mammaplasty: A 10-year follow-up

A retrospective study was undertaken to evaluate whether the initial outcome of two types of reduction mammaplasty techniques (vertical scar reduction mammaplasty vs. the inverted-T scar reduction mammaplasty) remains stable in the long term: Sixty-nine patients who had undergone breast reduction surgery in the period 1997-2000 at the Department of Reconstructive Plastic Surgery at the Medical Center of Leeuwarden were willing and able to participate in this study. A structured questionnaire was used to assess the degree of patient satisfaction. For subjective evaluation, the Strasser Grading System on photographs at the 3 months after surgery and after long-term follow-up (10 years) was used. The median general appreciation mark for the entire surgical procedure given by patients was 8 (1-10) on a scale from 1 to 10. Forty-six of the 69 patients could be scored according to Strasser: at 3 months in 17 patients (37%) the result was 'good', in 21 patients (46%) 'mediocre' and in eight patients (17%) 'poor'. After 10 years, in 37 of the patients (80%) the result was 'good', in six patients (13%) 'mediocre' and in three patients (7%) 'poor'. At 3 months, there was a higher incidence of bottoming out in the vertical scar group (one on two patients) as compared to the inverted-T scar group (one on 10 patients); however, at the 10-years follow-up bottoming out was 50% in the inverted-T scar group and 20% in the vertical scar group. Despite bottoming out, in both the vertical scar reduction mammaplasty technique and the inverted-T scar reduction mammaplasty technique, high patient satisfaction rates are achieved that remains for years.     

Short scar reduction mammaplasty in the bariatric patient

Reduction mammaplasty may be necessary even after massive weight loss. Patients typically present with unfavorable breast features such as significant loss of upper pole volume, inelastic skin, and severe ptosis. The most common approach in the United States has been the Wise-pattern inferior pedicle technique, emphasizing skin excision. This report presents the short scar vertical reduction mammaplasty approach for the bariatric patient population. It aims to demonstrate improved outcomes with less scar burden. The study included 15 women (n = 29 breast reductions) with mean age of 41.8 years. All the patients had undergone gastric bypass surgery, with mean weight loss of 109 pounds and mean body mass index of 33.3 kg/m(2). A modified superomedial pedicle vertical mammaplasty technique was used. New nipple position was placed lower than the inframammary fold in accordance with vertical lack of upper pole fullness. Suction-assisted lipectomy was used to contour the inferior pole of the breast before glandular resection. A full-thickness superomedial pedicle and median incision of the upper pole maximized pedicle safety. The mean breast resection was 605 g on the right side (range, 352-945) and 592 g on the left side (range, 360-908). Patient satisfaction was high, with pleasing and stable breast shape at long-term, and a mean patient-related aesthetic ranking of 4.3 of 5.0. No major complications were noted. It is shown that superomedial pedicle vertical reduction mammaplasty can be an alternative approach in bariatric patients, achieving long-term pleasing and stable results with significantly decreased scar burden.     

Histologic Profiles of Breast Reduction Specimens

Reduction mammaplasty is one of the most common procedures performed by plastic surgeons all around the world. This procedure is performed for aesthetic or reconstructive purposes, but also offers the opportunity to examine all resected breast tissue histopathologically. The purpose of this study was to evaluate the histologic diagnoses of the reduction mammaplasty specimens retrospectively and to determine the incidence of breast lesions in otherwise asymptomatic and healthy women. Therefore, 149 patients who had undergone reduction mammaplasty were reviewed with regard to their histologic diagnoses. We found that 61% of these women have pathologic alterations in at least one of their breasts, so each patient who requests a breast reduction surgery should be evaluated carefully and the specimens should be handled with particular care.     

Erysipelas-like inflammation following breast surgery.

Impaired lymph drainage is an inevitable consequence of any form of surgery that disrupts lymphatics, resulting in a degree of lymphoedema that may vary from subtle to dramatic and although classically involving an entire limb, may be more localised, confined to only a small area such as a skin flap. Infection is a well-recognised complication of lymphoedema. However, not all inflammatory episodes occurring in the setting of lymphatic dysfunction can be clearly attributed to infection as this article demonstrates. Five patients presented over a 5-year period with distinctive erysipelas-like inflammation affecting the breast which occurred several weeks following reduction mammaplasty in four patients and breast reconstruction in one patient. No clinical response was obtained with standard antibiotics. This inflammatory problem may represent a previously unreported complication of breast surgery with an incidence of 4% following reduction mammaplasty. Recent research supports the notion that this type of episode is most likely to be due to a non-infective inflammatory process related to lymphatic dysfunction induced by surgery.     

应用皮肤皱缩缝合技术行垂直切口乳房缩小整形术

目的　减少乳房缩小整形术所导致的切口瘢痕。方法　在做乳房缩小整形术时 ,在乳房下皱襞处不做切口 ,仅保留乳晕周围和乳晕下垂直切口 ,对乳房进行悬吊和塑形 ,而对乳晕下多余的皮肤和较长的皮肤切口 ,应用皮肤皱缩缝合技术进行缝合 ,利用组织的弹性 ,使其在手术后自动逐渐展平。结果　共为 13例患者实施了垂直切口的乳房缩小整形术 ,术后切口皆一期愈合 ,无血肿、感染、皮肤或乳头坏死等并发症发生 ,除 3例巨乳合并乳房严重松垂者半年后需再次对下皱襞处多余皮肤进行小的修整外 ,其余患者术后乳房和垂直切口形态满意。结论　垂直切口乳房缩小整形术设计、操作简单 ,容易掌握 ,效果恒定 ,在保证乳房缩小整形良好的乳房形态的同时 ,避免了在乳房下皱襞处的切口 ,是一种较好的乳房缩小整形术式。     

Outcomes in breast reduction surgery

Previous studies have established that patients with macromastia rate their physical and emotional health as substantially poorer than a control population. The aim of the current study was to confirm this discrepancy, and to evaluate the hypothesis that patients with macromastia who undergo bilateral reduction mammaplasty experience a marked improvement of their general health, both physical and emotional, when compared with their preoperative state and age-matched control population. Sixty-nine consecutive patients were enrolled and evaluated preoperatively and 9 months postoperatively. The methods used for patient evaluation were the Short Form SF-36, a health-related quality-of-life questionnaire, and the Brief Symptom Inventory (BSI), a self-reporting instrument used to assess psychological symptoms. Preoperatively, all patients reported physical health poorer than the age-matched control group. At 9 months postoperatively, patients reported substantial improvement in all areas measured by SF-36 and in the variables this study measured with BSI. Postoperative groups reported their health to be similar to the nonpatient control groups. These findings confirm the therapeutic role of bilateral reduction mammaplasty in alleviation of symptoms associated with macromastia and in restoration of normal physical and emotional functioning.     

A New Application for Increasing Breast Projection in Free-Nipple-Graft Reduction Mammaplasty

BACKGROUND: Free-nipple-graft reduction mammaplasty is the procedure of choice in patients with massive breast hypertrophy. Breasts that have undergone free-nipple-graft reduction mammaplasty usually cannot maintain projection. Many modifications of free-nipple-graft reduction mammaplasty have been described to treatment this problem. We describe our modification of the free-nipple-graft reduction mammaplasty. METHODS: The technique includes two key points: The first is the fold of the midportions of the breast. The second is suturing the midportion of the breast to the fascia of the pectoral muscle. The fold increases breast projection and the suturing helps to obtain long-lasting breast projection. RESULTS: A total of 16 patients underwent free-nipple-graft reduction with the modified technique between 2003 and 2008. Mean follow-up was 21 months (range = 3-60 months). An average of 2016 g of tissue per breast was excised (range = 1250-2700 g per breast). An average of 4031 g of tissue per patient was excised. All patients had long-lasting, pronounced breast mound projection. Satisfactory breast projection was maintained. No "bottoming out" was seen. The level of satisfaction felt by all patients was very high. CONCLUSION: Long-term projection can be maintained by suturing the half-trianges to each other and to the fascia of the pectoral muscle. One more useful alternative technique for increasing projection in free-nipple-graft reduction has been added with the technique presented.     

Reduction mammaplasty for the teenage patient: A critical analysis

Despite relatively few complications with reduction mammaplasty, there has been some hesitance to perform the procedure on the teenage patient. To examine the questions about teenage reduction, 16 teenage female patients were evaluated, all undergoing a modified McKissock technique. Followup averaging 42 months was obtained on 15 patients. Two complications were recorded. Subjective nipple sensation was the same or increased in 60% of our patient group. All patients were satisfied with their surgical results and relief of symptoms. The study revealed that reduction mammaplasty is a safe, viable surgical option for the adolescent female. Psychological, physical, and emotional symptoms are relieved.     

直线LEJOUR法乳房缩小术的临床应用

目的:探讨直线法Lejour术式对于肥大下垂乳房形态矫正的临床效果。方法:采用Lejour法术前设计,剥离皮肤及乳腺组织,切除下方和两侧皮肤皮下和腺体组织,形成上方腺体真皮蒂营养乳头乳晕,悬吊缝合腺体基底于第2肋水平,塑形成半球形后无张力缝合。结果:本组14例均获得满意的术后乳房形态,未发生乳头乳晕坏死,其中1例术后出现单侧乳头感觉迟钝,6个月后恢复,1例术后3个月切口下端"猫耳朵"予以手术修复。结论:直线Lejour法乳房缩小术设计操作简单、瘢痕短小、并发症少、效果良好,值得临床推广。