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。     

Zentrolaterales vertikales Mittelgesichtslifting

The use of the fiber endoscope video-assisted technique in facial rejuvenation is one of the most recent advances in aesthetic plastic surgery of the face. It offers the advantage of substituting the periorbital soft tissues without the necessity of skin resection and allows a vertical repositioning by mobilization of the frontoorbital and midface soft tissues. It can easily be done through a small incision of the scalp just behind the coronal incision and in the temporal area. The indications for this procedure are, however, limited to patients where a skin resection for the treatment by rhytidectomy is not necessary.     

Simultaneous breast augmentation and mastopexy

The results of combining breast augmentation and mastopexy are less predictable than those associated with mastopexy or augmentation mammoplasty alone. A method of breast skin envelope reduction is presented that allows the surgeon performing mastopexy to preview the final breast shape before committing to skin resection. This method, first described in 1978, has proven to be technically versatile and reproducible, and applicable not only to moderate (second degree) and severe (third degree) ptosis but also to simultaneous breast augmentation and mastopexy. For the combined procedures, the practical strategy proposed is first the implant placement through a periareolar incision, and a vertical transglandular incision, usually submusculofascial; second, restoring the gland anatomy by closing the muscularis and the vertical transglandular incision; third, skin envelope adjustment using the Tailor-Tack maneuver to accurately assure the best position of the nipple-areolar complex on the breast mound; fourth, skin incision, de-epithelialization and undermining; and finally, closure combining the the Purse-String maneuver with the vertical incision.     

经上腹正中切口制作横结肠袢式扭转造口临床分析

目的探讨经上腹正中切口制作横结肠袢式扭转造口的临床效果。方法在上腹正中做一纵切口,使之容纳5个手指,将横结肠提出并逆时针扭转90度,使之与切口方向一致,在横结肠下放置支撑棒,支撑棒两端与皮肤缝合固定。结果该方法可完全转流粪便,无并发症．3～6个月将造口还纳。结论经上腹正中切口行横结肠袢式造口术可避免腹直肌的损伤,符合微创理念。     

腹部皮肤横切口在前列腺切除术中的应用研究

目的:探讨腹部皮肤横切口在耻骨上前列腺切除术中的优势。方法:于2001年2月至2004年9月期间,将41名因BPH行耻骨上前列腺切除术的患者随机分为纵切口组20例及横切口组21例。并对两组的结果进行比较和统计分析。结果:横切口在术中及术后出血量、切口长度以及术后肛门恢复排气时间上均优于纵切口,差异有统计学意义(P<0.05)。结论:与腹部皮肤纵切口耻骨上前列腺切除术相比,皮肤横切口术式具有暴露好、术中及术后出血少、手术时间短、术后肠道功能恢复较快、切口愈合好且较美观等优点,值得临床推广应用。     

Submammary skin incision as a cosmetic approach to median sternotomy

Median sternotomy is the incision of choice to allow access to the anterior mediastinum, heart, or both lungs. The vertical skin incision leaves an unsightly scar for many female patients. A bilateral submammary horizontal skin incision with dissection of a flap including the subcutaneous tissue and breasts allows exposure of the sternum so that a median sternotomy can be performed. Since November 1981, we have used this incision 40 times in female patients undergoing open heart surgery. The exposure of the mediastinum was excellent, and there were no difficulties in cannulating the ascending aorta for cardiopulmonary bypass. Complications associated with this incision are insignificant if close attention is paid to details.     

小切口重度巨乳缩小术的临床应用

目的探讨一种切口瘢痕较小的乳房缩小整形术在巨乳治疗中的应用。方法去除乳晕周围皮肤的表皮，切除乳房下方梯形区域内的皮肤和乳腺组织，再以荷包缝合形成新乳晕，手术后仅在乳房下半留有一条垂直短小瘢痕。结果以该术式共治疗9例，效果良好，外观较满意，乳头血运、感觉良好，切口较隐蔽，并能够切除乳腺所有象限的肿物。结论该方法对于重度巨乳和合并有肿瘤的县乳的手术整复有其显著优点，值得推广。     

Comparison of transverse and vertical skin incisions for Caesarean section.

A comparison is made of the transverse and the vertical skin incision for Caesarean section. The advantages of the transverse incision are clearly demonstrated and discussed.     

上方宽蒂垂直切口乳房缩小成形术

目的 探讨一种减少患者乳头乳晕坏死的上方宽蒂垂直切口乳房缩小成形术.方法 采用Lejour穹窿顶式手术设计,切除乳房下方的皮肤、腺体,乳头乳晕以上方真皮腺体组织宽蒂抬高到正常位置,进行乳房塑形,术后仅留有垂直瘢痕.结果 采用上方宽蒂垂直切口方法行乳房缩小成形术46例,其中4例为单侧乳房缩小,手术效果满意,乳房形态良好.14侧乳房切口部分裂开,其中3侧经清创缝合愈合,其余经换药后愈合,无乳头乳晕坏死发生.结论 上方宽蒂垂直切口乳房缩小成形术效果良好,减少了乳头乳晕坏死的危险,值得推广应用.     

改良双环加垂直切口乳房下垂矫治术

目的：利用多种术式的有机结合,探讨乳房下垂的新的矫治办法。方法：从2005年3月至2013年6月,对于38例中重度乳房下垂患者,在传统的双环和／或加垂直切口的基础上,进行部分旋转折叠及多个楔形皮肤切除等改进,以缩短恢复期,提高手术效果。结果：通过38例患者的,临床观察及术后随访,发现运用该方法不仅能够有效地矫治中重度乳房下垂伴肥大,同时可以使乳房变得更加挺拔,有韧性,术后乳晕双环切口皱褶恢复明显缩短,垂直切口瘢痕的长度较短,瘢痕不明显。结论：改良双环加垂直切口的乳房下垂上提缩小术是一种较好的手术方法,值得临床推广。     

A geometric analysis of mastectomy incisions: Optimizing intraoperative breast volume

INTRODUCTION:

The advent of acellular dermis-based tissue expander breast reconstruction has placed an increased emphasis on optimizing intraoperative volume. Because skin preservation is a critical determinant of intraoperative volume expansion, a mathematical model was developed to capture the influence of incision dimension on subsequent tissue expander volumes.

METHODS:

A mathematical equation was developed to calculate breast volume via integration of a geometrically modelled breast cross-section. The equation calculates volume changes associated with excised skin during the mastectomy incision by reducing the arc length of the cross-section. The degree of volume loss is subsequently calculated based on excision dimensions ranging from 35 mm to 60 mm.

RESULTS:

A quadratic relationship between breast volume and the vertical dimension of the mastectomy incision exists, such that incrementally larger incisions lead to a disproportionally greater amount of volume loss. The vertical dimension of the mastectomy incision – more so than the horizontal dimension – is of critical importance to maintain breast volume. Moreover, the predicted volume loss is more profound in smaller breasts and primarily occurs in areas that affect breast projection on ptosis.

CONCLUSIONS:

The present study is the first to model the relationship between the vertical dimensions of the mastectomy incision and subsequent volume loss. These geometric principles will aid in optimizing intra-operative volume expansion during expander-based breast reconstruction.     

Submammary median sternotomy

A vertical skin incision is used as routine approach for sternotomy. The resulting scar is often disappointing and the top is visible and unpleasant, especially for young women. In 35 women ranging from 10 to 48 years (mean 29.2 years), median sternotomy was performed via a submammary skin incision. In all cases an open heart surgical procedure was performed. Adequate exposure of the heart was achieved in every case and there were no technical problems related to this approach, no hospital mortality or major complications. The cosmetic result is excellent and this approach is certainly justified in open heart surgery for young women.     

Natural-Looking Umbilicus as an Important Part of Abdominoplasty

The umbilicus is an important and essential aesthetic component of the abdomen. Many surgeons use different methods to relocate umbilicus during abdominoplasties. We prefer to use a simple combination of different well-known principles to form the neo-umbilicus. The main steps of the procedure are to make an elliptical vertical incision, to do vertical abdominal fascial plication, to embed the umbilical stalk in this plication by suturing the umbilical skin and the rectus fascia together to maintain the umbilical dimple, to place it at the vertical incision made in the abdominal skin at a predetermined point. Silk sutures are used for the abdominal fascial plication and neo-umbilical fixation. Liposuction from the neo-umbilicus to xiphoid along the midline of the upper abdomen creates a minimal superior sulcus. In each patient, a three-dimensional umbilicus with sufficient depression was obtained. All patients, including one case with complications, were pleased by the final aesthetic results. This study has been presented at the XVI Congress of ISAPS held in Istanbul, Turkey, May 26–29, 2002     

Torsoplasty After Important Weight Loss

Weight loss exceeding 40 kg frequently causes excess skin on the lateral and posterior chest wall. Other authors have suggested surgical dissection of the excess skin using horizontal incision or, alternatively, using a vertical incision positioned in the axillary region. This procedure is incomplete and does not correct the skin ptosis in the subaxillary lateral chest wall. The current authors propose a surgical technique that permits resection of excess skin and lifts the torso on the back, positioning the scars on the anterior axillary pillar and around the breast. This treatment is performed for the patient after significant weight loss. The scar normally is hidden behind the anterior axillary pillar on the axillary fold.     

Comparison of double vertical incision with various tubularization techniques and its clinical application

INTRODUCTION: Tubularization is one of the indispensable practices of reconstructive surgery, especially in the repair of hypospadias. In all procedures of forming a tube, the desired diameter should be reached without any complication. MATERIALS AND METHODS: We used as a new technique, 'double vertical incision', in 8 rabbits and compared it with free skin graft, local flap and single vertical incision. We formed 32 tubes randomly around an 8-french catheter using 7/0 PDS suture. Twenty-one days after the operation, the tubes were taken, randomized to staining with hematoxylin and eosin and with Masson's trichrome and then subjected to histopathological examination. Inflammation, fibrosis and lumen diameter were statistically evaluated. RESULTS: Widest lumen diameters were found in the double incision group and this result was statistically different when compared with the results of the other groups (p < 0.001). CONCLUSIONS: Double vertical incision is promising in that it is easier to perform, provides a desired amount of tissue in cases in which the urethral bed is narrow, and causes no scar. Based on the results we obtained, we applied double vertical incision, a modification of tubularized incised plate urethroplasty popularized by Snodgrass, in 4 patients. The tubes were not distended, their long-term follow-up showed no complication and a urethra of the desired diameter was obtained.     

A comparative study between longitudinal and "T" incisions for dorsal plating of the distal radius

A retrospective review of 24 patients with dorsal incisions for open reduction and internal fixation of Frykman VII/VIII distal radius fractures using a dorsal plate was performed. Half of them had a longitudinal incision while the other half had a T-shaped incision. No difference in the healing properties or wound morbidity could be demonstrated between the two groups. However, the T incision provided improved exposure of the distal radius and patient satisfaction with its cosmetic result was superior. The horizontal limb was well camouflaged within the transverse skin crease on the dorsal aspect of the wrist. The vertical limb did not extend into the dorsum of the hand and could, therefore, be hidden by appropriate clothing.     

微创法重睑成形术

传统的切开法重睑术中多将重睑设计线下的皮肤、皮下及眼轮匝肌等组织一并切开,切口下垂直切口方向的皮下静脉血管不可避免的将被损伤,术中出血多,组织损伤大,是术后上睑肿胀的主要原因。术者在行切开法重睑术中,用显微外科手术器械及显微外科手术操作技术,术中保留垂直切口方向的皮下较粗的静脉血管,保护切口下缘皮肤真皮下血管网的完整,较好地弥补了传统切开法重睑术的上述缺点。     

Transposed skin graft for wound closure after Cincinnati incision Experience in 7 patients with severe foot deformities

I report a technique of wound closure by a transposed skin graft after operative treatment of foot deformities, using a Cincinnati incision. Three-dimensional correction of severe foot deformities (congenital talipes equinovarus, congenital vertical talus, etc.) results in skin excess on one side of the foot and lack of this on the opposite side. The skin excess can be cut out and used as a full-thickness skin graft for wound closure on the opposite side of the foot.     

剖宫产术腹部纵切口立"8"字缝合预防脂肪液化的效果观察

目的　探讨皮肤和皮下脂肪立“8”字缝合对预防剖宫产术腹部纵切口因脂肪液化而非感染性部分裂开的效果。　方法　将皮下脂肪组织厚达 5cm以上的患者 6 0例 ,随机分为两组 :观察组 30例 ,采用立“8”字缝合皮肤和皮下组织 ;对照组 30例 ,采用传统缝合方法。　结果　观察组切口一期愈合率 96 .6 7% ,显著高于对照组的 73.33% (P <0 .0 1) ;脂肪液化切口裂开 3.33% ,显著低于对照组的 2 6 .6 7% (P <0 .0 5 ) ;术后平均住院日显著少于对照组 (P <0 .0 1)。切口部分裂开的 9例中 5例采用立“8”字二期缝合 ,治愈率达 10 0 %。　结论　脂肪组织厚达 5cm以上的切口 ,采用立“8”字缝合皮肤及皮下脂肪对预防剖宫产术腹部纵切口脂肪液化切口裂开是一个简便易行、疗效可靠的方法 ,值得临床推广。