【摘要】 目的 探討肥胖人群減肥后體重急劇下降導致腹壁松弛行腹壁整形手術的療效。 方法 2003年4月-2009年10月，24例減肥后體重下降導致腹壁松弛患者中男3例，女21例，年齡28~44歲，平均36歲。其中1例合并甲狀腺功能亢進，1例合并糖尿病病史；20例均通過運動、控制飲食等方式致體重下降，4例接受胃減容手術后體重下降。體重下降穩定后至腹壁整形手術時間間隔2~4年，平均2.5年；減肥前至腹壁整形手術前體重下降37~67 kg，平均下降45 kg。手術采用屈髖位，切除松弛皮膚組織，收緊腹壁及腰部松弛組織，恥骨上沿皮瓣遠端去表皮后與恥骨上沿骨膜縫合固定。所有患者隨訪5個月~2年。 結果 23例術后2周皮瓣完全成活，切口愈合良好，無切口感染；1例術后出現恥骨上切口約2 cm表皮裂開，換藥2周后切口愈合，術后腹壁平整、對稱，無皮下血腫發生。隨訪期間切口疤痕隱蔽，陰阜無上移，腹壁平坦、對稱。 結論 該腹壁整形手術方式效果良好，術后并發癥少，值得推廣。From April 2003 to October 2009, 24 obese patients, including three males and 21 females, developed abdominal chalastodermia caused by weight loss. Their age ranged from 28 to 44 years old with an average age of 36 years. Among them, one had hyperthyroidism and one had a medical history of diabetes. Twenty patients lost weight by exercise and diet, while the other four lost weight through stomach reduction surgery. Time span from weight loss to abdominal plastic surgery was two to four years, averaging at 2.5 years. During the time from before weight loss until the surgery, weight loss ranged from 37-67 kg, averaging at 45 kg. The surgery adopted the position of bending hip. The loose skin was removed; abdominal wall and loose waist tissues were tightened; and the far end of flap without skin along the upper edge of pubis was sutured with the periosteum. All patients were followed up for a time ranged from five months to two years. Results Flaps survived within two weeks after the surgery, incision healed perfectly, and no infection occurred to the incision for all the patients except in one case, there was a 2 cm of skin fissure in the upper incision which was cured after two weeks of dressing. After the surgery, the abdominal wall was flat and symmetrical without subcutaneous hematoma. During the follow-up, scars were well hidden, mons pubis was not shifted upward, and the abdominal wall was flat and symmetrical. Conclusion The abdominal wall plastic surgery has a good clinical outcome with few complications, which is worth being popularized.
Based on skin elasticity and mobility, V-Y advancement flaps are designed to repair wounds. Traditional V-Y flaps have been limited due to short advancing distance. With the development of perforator flaps and the application of microsurgical techniques, V-Y advancement flaps are gradually transiting from traditional random flaps to axial flaps containing well-known vessels or perforator arteries. The advancing distance of V-Y advancement flaps is significantly increased, and the design forms are gradually flexible and diversified. V-Y advancement flaps are widely used in clinical practice and can be used to repair wounds in almost all parts of the body. This article reviews the clinical application progress of V-Y advancement flaps to further promote its clinical application.
OBJECTIVE To study the influence and mechanism of gamma-IFN on fibroblasts in hypertrophic scars(HTS). METHODS The cultured fibroblastic cells were isolated from the hypertrophic scars of 10 patients. The fibroblasts were divided into two groups, one group was treated with gamma-IFN (100 U/ml, 5 days) and the other without gamma-IFN as control. The proliferative activity in both groups was investigated and compared by blood cytometer, the proportion of myofibroblast (MFB) and the ratio of apoptosis were examined and analysed between two groups by flow cytometry using alpha-smooth muscle actin (alpha-SMA) as marker. RESULTS The proliferative activity was downregulated with gamma-IFN. In gamma-IFN treated group, the differentiation of MFB were reduced and the decreasing ratio was 3.2% at the 2nd day and up to 10.5% at the 8th day, then it reduced gradually. The apoptosic ratio is 17.7% in gamma-IFN treated group, and is 10.9% in control group. The difference was statistically significant. CONCLUSION gamma-IFN could downregulate the proliferation of fibroblasts, decrease the differentiation of MFB and induce the apoptosis. It has beneficial effect in the treatment of hypertrophic scars(HTS).
Objective To explore the clinical application effects of cervical advancement flaps in repairing mandibular scars. Methods A retrospective analysis was performed on the clinical data of patients with mandibular scars admitted to the Department of Plastic and Burn Surgery of West China Hospital of Sichuan University between January 2018 and July 2020. The lateral X-ray images of the patients were analyzed before and 2 weeks after surgery, and the differences in the mento-cervical angles and the cervico-mental angles before and after surgery were compared. Results A total of 21 patients were included, including 7 males and 14 females. At admission, all patients had a mandibular scar area of (3-7) cm × (3-6) cm, and underwent primary repair with cervical advancement flaps. All patients had good postoperative skin flaps survival, primary wound healing, and obvious mento-cervical angle and cervico-mental angle. The preoperative mento-cervical angle was (110.24±9.47)°, and at 2 weeks post surgery, the mento-cervical angle was (98.39±4.95)°, with a statistically significant difference (P<0.05). The preoperative cervico-mental angle was (134.15±6.00)°, and at 2 weeks post surgery, the cervico-mental angle was (126.44±3.60)°, with a statistically significant difference (P<0.05). Conclusion The neck advancement flap is an effective surgical method for treating simple mandibular scar, which is simple and can improve the appearance of the jaw and neck.
