SMAS瓣"不动区"的有限性剥离在除皱术中的应用  

Contained dissection on the immobile zone of SMAS for facial rhytidectomy

作　　者：吴乐昊 张畅 李无言 王太玲 王佳琦 Wu Lehao;Zhang Chang;Li Wuyan;Wang Tailing;Wang Jiaqi(Department of Cervicofacial Plastic and Reconstructive Surgery,Plastic Surgery Hospital,Peking Union Medical College,Chinese Academy of Medical Sciences,Beijing 100144,China)

机构地区：[1]中国医学科学院北京协和医学院整形外科医院面颈整形美容中心,100144

出　　处：《中华整形外科杂志》2021年第2期198-204,共7页Chinese Journal of Plastic Surgery

基　　金：中国医学科学院整形外科医院院所基金(YS202037)。

摘　　要：目的探讨在有限范围内处理浅表肌肉腱膜系统(SMAS)瓣的不动区,进行面部多层次剥离悬吊除皱手术的术后效果。方法自2014年1月至2019年12月,中国医学科学院整形外科医院面颈整形美容中心采用有限范围内剥离SMAS瓣不动区的方法开展面部除皱术110例,其中男1例,女109例,年龄46~72岁。术中皮瓣剥离范围与经典的除皱范围相似,SMAS层的处理范围集中在颧颊部的不动区。以轻拉SMAS瓣能看到鼻唇沟的深度和走行角度改变、口角提升、口周垂肉上移为剥离到位的标准。每剥离1 cm的SMAS瓣,进行1次动态评估。如果能观察到鼻唇沟的深度和走行角度随着牵拉而发生改变则停止向内剥离,对于不动区的处理停止;否则继续向内剥离。最后,按经典的多层次悬吊原则,达到面部年轻化的目的。术后对患者主观满意度、局部改善情况以及并发症进行调查。结果本组110例,所有患者均获随访,时间为6~30个月,平均12个月。患者主观满意率为94.5%(104/110),其中十分满意61例,满意43例,可接受2例,不满意4例。所有患者均表示眉下垂、鼻唇沟、口角位置、口周垂肉、皮肤质地情况有改善。术后早期并发症为局部血肿4例(3.6%)。远期并发症为耳前、耳后瘢痕过宽或增生3例(2.7%)、耳垂移位2例(1.8%)、颞部切口无毛发区过宽1例(0.9%)。结论SMAS瓣不动区的有限剥离对除皱手术的术后效果无明显影响,可以实现并维持较好的面部年轻化治疗效果,同时降低手术并发症风险。Objective To introduce the clinical experiences in multilevel suspension rhytidectomy with limited dissection of the immobile zone in superficial musculoaponeurotic system(SMAS).Methods From January 2014 to December 2019,at total of 110(1 male and 109 females,46-72 years old)cases of facial rhytidectomy were performed in our institution.During the operation,the area of skin flap elevation is similar to the classic rhytidectomy.SMAS layer dissection is contained within the immobile area.Dynamic evaluation was conducted every 1 cm of SMAS flap elevation,by gently pulling the SMAS flap.The change of depth of the nasolabial fold,the change of lips elevation were the parameters for which the degree of dissection is determined.The subjective satisfaction and overall improvement were investigated and the complications were recorded.Results All 110 patients were followed up for 6-30 months,with an average of 12 months.The subjective satisfaction rate was 94.5%(104/110).Among them,61 cases rated"very satisfied",43 cases were"satisfied",2 cases were"acceptable"and 4 cases were"unsatisfactory".All patients had significant improvement on brow sagging,nasolabial fold,mouth sagging,and skin texture.The early postoperative complications were local hematoma in 4 cases(3.6%).The long-term complications included 3 cases(2.7%)of periauricular scar hyperplasia,2 cases(1.8%)of earlobe displacement and 1 case(0.9%)of hair loss at temporal incision(0.9%).Conclusions Limited dissection of the immobile zone in SMAS flap has no significantly negative impact on the overal outcomes.By such contained surgical dissection,facial rejuvenation can be achieved,and the risks of complications were reduced.

关 键 词：表浅肌肉腱膜系统 面部 解剖 悬吊 

分 类 号：R622[医药卫生—整形外科]