重睑成形术后发生上睑下垂的原因分析及其防治

目的 探讨重睑术后发生上睑下垂的原因及早期防治方法，避免术后医疗纠纷的发生。方法 对拟做重睑术的患者，术前详细询问病史并认真查体。对18例术前发现有睁眼乏力或轻度上睑下垂者，采用切开法重睑术并同时行上睑提肌缩短术，对3例切开法重睑成形术后，出现上睑下垂并发症者即刻打开切口行上睑提肌缩短术；对5例埋线法术后出现上睑下垂者在7d内拆除缝线，重新设计重睑线。无论切开法或埋线法，如超过10d即均在3个月后再行切开法重睑成形术。结果 对26例术前存在或术后发现的轻度上睑下垂者重行手术修复，24例随访3个月至2年，医者与受术者双方满意或基本满意。结论只要遵循预防为主、早期发现、早期治疗的原则，重睑成形术后出现上睑下垂这一特殊并发症是可以治愈的。     

改良术式切开内固定重睑成形术

目的：探讨改良切开内固定法重睑成形术的临床应用及体会。方法：以2019年1月-2020年1月在笔者医院行双侧改良切开内固定法重睑成形术的280例就医者为研究对象。将切口下唇眼轮匝肌-睑板前筋膜-提肌腱膜与眶隔融合部残端-上唇轮匝肌进行固定以形成重睑。观察手术一期愈合率、就医者满意度及术后并发症情况。结果：术后随访6～24个月，所有就医者均一期愈合，就医者术后重睑形态满意度为96.42%(270/280)，无严重并发症发生。结论：改良切开内固定法重睑成形术术后重睑形态自然，就医者满意度高，临床疗效显著。     

重睑术的并发症及其处理

目的：探讨重睑术的并发症及其处理方法。方法：回顾1993年至2001年共行重睑术5673例，术后不理想者729例，占重睑术的13％。并发症主要有：双侧不对称、重睑线变浅或消失、内外眦成形不理想、多层重睑、上睑紧缩及异物感、烧结外露、表皮祥囊肿、皮下异物性结节、上睑瘢痕、上睑下垂。分析其形成的原因，并提出了治疗方法。结果：本组出现并发症者729例，经重新手术修整，术后效果满意。结论：重睑术的术式定型、操作简单，但仍有一定比例并发症出现，应引起重视。     

切开法重睑术并发症的原因分析及对策

目的　探索切开法重睑术后并发症的处理方法。方法　对447例切开重睑失败者进行了原因分析，介绍了相应的处理措施。结果　447例重睑者中，除5例需第3次修复外，其余都取得了令人满意的效果。结论　切开法重睑术虽较其它的重睑术难以掌握，但只要对其形成机理及眼睑的解剖有较深的认识，术中注意每一操作细节，即不难取得理想的效果。     

切开法重睑术后不良重睑的原因分析及处理原则

目的 探索切开法重睑术后不良重睑的处理方法.方法 对切开法重睑术后不良重睑的52例患者,进行了原因分析和相应的处理.结果 52例不良重睑者中,3例修复效果欠佳,其余效果令人满意.结论 重睑术后不良重睑经恰当处理,绝大部分是可以修复的.     

切开法重睑成形术后并发症的预防及处理

目的：探讨切开法重睑成形术后并发症的预防及处理。方法：注重手术每一环节的细节处理技术并注重整体把握的处理策略行重睑成形术162例,其中合并内眦赘皮47例,上睑脂肪较多30例,上睑皮肤松弛17例,泪腺脱垂6例,14例为第2次手术,5例为第4次手术。年龄17～61岁,平均29岁,男17例,女145例。结果：所有就医者麻醉满意,各手术操作步骤动作到位,稳、准、轻、快,术后无感染,切口一期愈合。重睑中间部分距睑缘平均宽度为（7.50±0.80）mm,重睑线自然流畅,闭眼时切痕不明显,两侧的对称性较好。结论：注重切开法重睑成形术的操作细节并整体把握对取得自然的重睑效果非常重要,可显著减少术后并发症。     

重睑术后并发症探讨和处理

我院自1985年至2005年共行重睑术6783例．术后不理想590例（8．7％）。主要并发症有：双侧不对称、重睑线变浅或消失、内外眦成形不满意、多层重睑、三角眼、上睑窝过度凹陷、缝线外露、皮下囊肿、上睑下垂、上睑瘢痕、角膜损伤。出现并发症不满意者经重新手术修复，术后效果满意。重睑术有三种术式，即压线法、埋线法及切开法重睑术。由于眼型差异及术者经验的不同，术后常出现各种并发症，本文分析其原因，并简述治疗方法。     

重睑术的并发症及其处理

目的　探讨重睑术的并发症及其处理方法。方法　回顾 1993年至 2 0 0 1年共行重睑术 5 6 73例 ,术后不理想者 72 9例 ,占重睑术的 13 %。并发症主要有 :双侧不对称、重睑线变浅或消失、内外眦成形不理想、多层重睑、上睑紧缩及异物感、线结外露、表皮样囊肿、皮下异物性结节、上睑瘢痕、上睑下垂。分析其形成的原因 ,并提出了治疗方法。结果　本组出现并发症者 72 9例 ,经重新手术修整 ,术后效果满意。结论　重睑术的术式定型、操作简单 ,但仍有一定比例并发症出现 ,应引起重视     

重睑术的并发症及其处理

目的探讨重睑术的并发症及其处理方法.方法回顾1993年至2001年共行重睑术5?673例,术后不理想者729例,占重睑术的13%.并发症主要有双侧不对称、重睑线变浅或消失、内外眦成形不理想、多层重睑、上睑紧缩及异物感、线结外露、表皮样囊肿、皮下异物性结节、上睑瘢痕、上睑下垂. 分析其形成的原因,并提出了治疗方法.结果本组出现并发症者72 9例,经重新手术修整,术后效果满意.结论重睑术的术式定型、操作简单,但仍有一定比例并发症出现,应引起重视.     

重睑变单睑手术方法探讨

重睑术位居美容外科之首，然而由于各种原因造成的重睑术后并发症［１］，也为当今美容外科常见问题，我们几年来先后为重睑术后因故要求恢复单睑者治疗８例，效果满意。１　手术方法１１　埋线法重睑术后时间较短者（１个月以内），可在触及的皮下线结用４号针头钩出缝线拆除之，术后配合牵拉按摩眼睑皮肤以巩固疗效。１２　对切开法重睑及缝线法和埋线法时间较长，且皱褶上皮肤又不很松弛者，可经原切口切开后去除前次手术瘢痕，彻底松解纤维粘连部位，使重睑消失。然后切开眶隔，将部分眶隔后脂肪呈惟幕状下移，置于睑上提肌腱膜与眼…     

双V形切口法Ⅰ期内眦赘皮矫正及重睑成形术

目的探讨一种伴有内眦赘皮单睑者于行切开重睑成形术的同期进行内眦赘皮矫正术,使内眦部位瘢痕隐蔽的一项手术方法。方法设计内眦横行切口线、重睑线和下睑弧形切口线。横行剪开内眦皮肤的长度达新设计的内眦点,纵行剪开部分内眦韧带前脚,将内眦韧带前脚的内眦侧断端向鼻侧牢固地固定在鼻背筋膜上。常规行切开重睑成形术,去除新内眦上端多余小三角形皮肤及下方部分片状眼轮匝肌。沿下睑缘距睫毛下1～2mm处向颞侧弧形切开达下睑“猫耳”消失处,向下分离内眦下方下睑皮瓣,剪除赘皮和部分眼轮匝肌。缝合皮肤,使术后瘢痕隐蔽,睑裂增大,赘皮消失。结果23例46只眼,睑裂增大2～4mm,内眦赘皮消失,重睑形成,内眦部位瘢痕隐蔽,外形满意。结论手术方法简单,内眦部位瘢痕隐蔽,可与切开法重睑成形术同期进行,除2例半年至1年内内眦瘢痕轻度增生外,余均取得满意的疗效,尤其适合于严重的正向型和倒向型内眦赘皮的手术矫正。     

Partial-incision technique for creation of the double eyelid

Background: Three principal techniques exist with which to create the Asian double eyelid: the suture, partial-incision, and full-incision methods. The partial-incision method is reliable and long-lasting without many of the drawbacks of the full-incision method. Objective: The surgical technique of the partial-incision method is reviewed in a stepwise fashion so that the reader can reproduce this method for double-eyelid creation. Methods: Preoperative lid measurements were made with the patient in an upright sitting position to account for the effects of gravity on the lid. An incision was made through both the skin and orbicularis muscle to expose the underlying orbital septum. The lateral septum was lifted upward and a small wedge of elevated septum removed to permit entry into the preaponeurotic adipose tissue, which was then teased forward through the aperture in the orbital septum. Normally, only half of the exposed fat is removed, leaving a small adipose cuff on the hemostat. The remaining adipose cuff was cauterized and the wound inspected for hemostasis. Suture fixation was accomplished with a 7-0 nylon suture to tack the levator aponeurosis to the inferior skin edge along the incision line. The suture was passed through the epidermis to ensure permanence. Results: We have successfully used the partial-incision method of double-eyelid correction in 1500 cases. The 3 notable complications that can occur are loss of the lid crease, suture extrusion, and asymmetry. All of these complications occur in approximately 2% to 3% of cases but are easily corrected. The apparent elevated appearance of the lid height during the postoperative period is attributed to edema and diminishes by 1 to 2 mm to a more natural position after 3 to 12 months. Conclusions: The partial-incision approach is a simple, safe, and straightforward approach to double-eyelid creation that can be performed even by surgeons with relatively little experience in the technique. (Aesthetic Surg J 2003;23:170-176.)     

A Two-Way Continuous Buried-Suture Approach to the Creation of the Long-Lasting Double Eyelid: Surgical Technique and Long-Term Follow-Up in 51 Patients

Background  Although it is seldom reported in the Western literature, the buried-suture operation to create a double eyelid is very popular in Asia. However, the buried-suture methods are traditionally associated with a high recurrence rate. Corneal damage and exposed conjunctiva suture are also possible. Methods  The two-way continuous buried-suture approach was applied in double-eyelid operations. With seven to nine stab skin wounds on the upper eyelids, a continuous single-armed suture is passed through the dermis as well as the superficial part of the tarsus. Then the needle is inserted in the opposite way. Both ends of the suture are tied within the far lateral incision. The operation takes no longer than 20 min. The scars of the stab incision were no longer visible after several months postoperation. Results  From August 2003 to January 2008, 51 patients underwent this technique. All patients have been satisfied with their appearance after their initial surgery except two patients who had minimal associated morbidity. No disappearance of the formed double eyelids or corneal damage occurred. Conclusion  The two-way continuous buried-suture approach is a simple method for establishing a long-lasting double eyelid. The results are durable and the potential for corneal injury is reduced.     

小切口联合埋线重睑术的临床应用

目的:探讨埋线重睑术的手术方法.方法:患者取站立位或坐位设计重睑宽度,一般6～8mm,设计内、中、外三点.外侧点位于外眦内侧约5mm,以外侧点为中心设计长约5mm,位于重睑线上的切口线.切开皮肤,去除眼轮匝肌,打开眶隔,去除眶隔脂肪,彻底止血后,按切开重睑的方法,用6-0美容线带提上睑肌腱膜将伤口缝合,内中二点行埋线重睑.结果:本组56例,术中取出适量眶隔脂肪,组织量类似切开重睑.上睑臃肿明显减轻,外侧小切口瘢痕不明显,效果满意.结论:上睑不松弛,但臃肿者,小切口埋线重睑是一较好的选择.     

Celebrity Arcade Suture Blepharoplasty for Double Eyelid

Background In Taiwan, double-eyelid surgery is the most popular cosmetic surgical procedure. The technique preferred by plastic surgeons is the incision method because it is believed that this method can provide stable double-eyelid results. It is the authors’ observation that patients prefer an invagination fold rather than a significantly high fold. Suture blepharoplasty may create a relatively even and symmetric invagination fold. In the past, the major disadvantage of the suture technique has been the opinion that the double fold fades away. Methods The celebrity arcade suture (CAS) technique was applied in double-eyelid operations. The CAS technique includes three major techniques: stabbing incision, transtarsal suture, and bridge connection. The whole procedure can be completed in 15 min. From June 2001 to November 2004, 312 patients underwent the CAS technique. Results Of the 312 patients who underwent the CAS technique, 5 required a revisit, with 3 of these returning patients reporting fold disappearance. These three patients received repeat suture procedures. Conclusions The findings show that the CAS technique is a reliable method for establishing a smooth, constant, and symmetric double eyelid, and that CAS requires only a short recovery time.     

跟骨外侧延长L形切口并发症的危险因素分析

目的 :探讨跟骨外侧延长"L"形切口治疗闭合性跟骨骨折术后发生切口并发症的相关危险因素,明确降低切口并发症的有效干预手段。方法:回顾性分析2011年1月至2015年1月收治的285例(315足)行跟骨外侧延长"L"形切口治疗闭合性跟骨骨折患者的临床资料,对可能影响术后切口并发症的18个临床相关危险因素进行单因素分析,对存在统计差异的变量再给予多因素Logistic回归分析。结果:285例(315足)共有29例(30足)出现切口并发症,其中切口皮缘红肿渗出、不愈合9足,皮缘发黑坏死或者切口裂开16足,皮肤软组织浅层感染3足,骨髓炎2足。单因素分析结果显示:坠落高度(P=0.017)、糖尿病病史(P=0.026)、吸烟史(P=0.001)、手术时间(P=0.003)4个因素差异有统计学意义,将这些因素再进行多因素Logistic回归分析,发现糖尿病(P=0.029)、吸烟史(P0.001)、手术时间(P=0.018)是跟骨外侧延长"L"形切口术后并发症的危险因素。结论 :术前戒烟、积极控制血糖以及熟悉手术操作,有效减短手术时间可以减少跟骨外侧延长"L"形切口并发症的发生率。     

Inhibitory effects of local pretreated epidermis on wound scarring: a feasible method to minimize surgical scars

OBJECTIVE: To inhibit surgical scarring by pretreating epidermis at the operation site. METHODS: Eight patients who were to undergo operation through a modified incision incisions technique and other eight subjects presenting for skin grafting were recruited. For the modified incision patients a method to make the site 'epidermis-free' was developed. At the operating site a split thickness rectangular skin flap was raised with a width of one cml transverse to the incision direction. Incision was then made through the exposed dermis. The flap was repositioned onto the incision site after intradermal suturing of the incision line following the subcutaneous operation. When skingrafting the graft was used in extended form by de-epithelialising the margins of the wound by 1cm before graft placement. Then a skin graft with medial full-thickness and marginal split-thickness areas was transplanted onto the extended wound. In the control site-matched groups, surgical skin incision and skin grafting were performed as usual. Clinical observation and immunohistological examination were applied to evaluate the wound healing and scar formation in all subjects. RESULTS: Both epidermis-free incision and extended skin graft sites showed perfect wound healing with short-term subjective scarring disturbance and slight wound scars, different from the control groups. The histological results showed the healing tissues in the experimental groups were more similar to normal dermis than those in the control groups. The immuoreactivities of type I and type II collagen in epidermis-free incision were both much lower than those in the control incision and the ratio of type I to type III collagen in the experimental incision was nearer to normal value. CONCLUSION: Pretreating local epidermis can effectively minimize postoperative scarring by modulating collagen synthesis.     

一点双线套缝埋线法行重睑成形术

目的：探讨一种有效的方法使埋线法重睑术后疗效更稳定,重睑线不易消失,达到持久而良好的美容效果.方法：在术中每一埋线定点部位埋入相互部分重叠的两根缝线,使需粘连处成为一小短线连接,其余方法同传统埋线法.结果：全组30例患者及医生对重睑效果均满意,术后出现线结外露等并发症经简单处理未影响重睑效果.结论：运用一点双线套缝埋线法使重睑术的力学关系更合理,效果更可靠.     

重睑成形术中矛头状皮肤切除术矫正内眦赘皮

目的:探索重睑成形术中内眦赘皮矫正术的新方法。方法:在内眦部位设计矛头状皮肤切口上方与重睑线连接,下方沿下睑延长,水平切断内眦处的眼轮匝肌纤维,横向缩短内眦韧带,将赘皮缘推进缝合至鼻侧切口,消除引起赘皮的解剖学因素。结果:临床应用30例对25例进行了为期1～12个月的随访,结果所有患者的重睑形态满意,内眦矫正充分、瘢痕隐蔽。结论:此方法能充分矫正内眦赘皮,适合于重睑成形术同期施行,是一种操作简单效果满意的方法。