颈后切口皮瓣紧缩术矫治“火鸡颈”(1)
[摘要]目的：创新一种解决颈部严重皱纹的切口隐蔽、安全、简单、持久的手术方法。方法：利用皮瓣组织的弹性和塑性蠕变的力学特征和颈部前方疏松后方坚实的解剖特点，设计颈部后方切口，通过深层减张缝合，尽可能大量切除松弛皮瓣组织，造成持久的对成纤维细胞的张力刺激和细胞营养改善，使皱纹区恢复年轻化的生理和外观状态。结果：本组9例严重颈部皱纹患者(三～四级)，术后皱纹基本消失或减轻2级以上，7例满意，2例基本满意。结论：颈后切口皮瓣紧缩术是一种颈前方无切口瘢痕的专门治疗严重颈部皱纹的安全、简单、效果持久的手术。
[关键词]颈部;皱纹;“火鸡颈”;皮瓣紧缩术;颈后切口;皮瓣张力;瘢痕
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2020)10-0078-04
Effect of Skin Flap Constriction Through Posterior Cervical Incision for Correction of “Turkey Neck”
ZOU Yu-chao1，ZOU Yu-mei1，WAN Xing-bo2
(1.Zou Yuchao Medical Beauty Clinic，Dongan District，Mudanjiang City，Mudanjiang 157005，Heilongjiang，China;2.Department of Surgery， Jidong County Maternal and Child Health Hospital， Ji`xi 158200，Heilongjiang，China)
Abstract： Objective To develop a safe， simple and lasting surgical method for the treatment of severe wrinkles in the neck. Methods The elastic and plastic creep characteristics of the skin flap tissue and the solid anatomical characteristics of the loose rear in the front of the neck were used. The posterior incision of the neck was designed， and the loose skin flap tissue was removed as much as possible through deep tension-reducing suture， resulting in lasting tension stimulation to fibroblasts and improved cell nutrition， so that the wrinkle area returned to a younger physiological and appearance state. Results In 9 patients with severe neck wrinkles， the wrinkles disappeared or reduced by more than 2 grades. 7 cases were satisfied and 2 cases were basically satisfied. Conclusion Posterior cervical incision skin flap tightening is a safe， simple and long-lasting operation for the treatment of severe neck wrinkles without incision scar in front of the neck.
Key words： neck; wrinkles; “turkey neck”; skin flap tightening; posterior cervical incision; flap tension; scar
当今面部及五官整形除皱手术发展迅速，手术方式多种多样，技术成熟效果显著，唯独脖颈部位，缺少简单易行同时效果显著持久的技术，而脖颈部位于人体正面显著又难以掩盖的部位，特别在夏季和温热带地区，对于面部和五官都可以进行很好地美容修饰，唯独脖颈部皱纹难以通过美容整形解决，对爱美人士是一件难以接受的事情，对演艺明星则影响其艺术事业发展。从2011年以来特别关注和研究了脖颈部的美容整形手术的问题，并分别以皱纹及皮瓣松弛的轻重划分为四级，给予不同的治疗方法，特别是三～四级，皮瓣最严重松弛和皱纹密集难以解决的俗称“火鸡颈”，采用颈前无切口瘢痕的颈部后方皮瓣紧缩术，除皱效果显著持久。
1 资料和方法
1.1 病例资料：收集2011年-2019年笔者医院收治的9例患者，全部为女性，年龄53～68岁，均为三～四级皱纹，皱紋已经持续多年并逐渐加重，都曾经咨询多地整形医院，未接受全面-颈部除皱手术，愿意接受本手术方式和颈部后方遗留永久瘢痕。一次手术者4例，5例于第一次术后4～9个月行二次手术，随访4～15个月，平均随访9个月。
1.2 颈部皱纹分级：现有的颈部皱纹分级方法涵盖的皱纹范围不足，没有对严重的皱纹和皮瓣松垂分级，为了方便治疗方案的选择，本次按照下列程度分为四级：①一级：横行较深皱纹1～2条或皮下脂肪萎缩皮瓣松弛，两手指可将皮瓣捏起的高度小于1cm;②二级：横行较深的3条皱纹或皮下脂肪萎缩皮瓣松弛，两手指可将皮瓣捏起的高度大于1cm小于2cm;③三级：横行皱纹4条或皮下脂肪萎缩皮瓣松弛，两手指捏起皮瓣的高度大于2cm小于3cm，或出现持久存在的纵向突出的皮瓣条，或者出现网状皱纹;④四级：横行皱纹5条以上或皮下脂肪萎缩，两手指捏起皮瓣的高度大于3cm，或出现持久存在的纵向突出皮瓣条两条以上或持久的纵向皮瓣条高度超过1cm或面积大且深在的网状皱纹。, 百拇医药(邹毓超 邹毓美 万兴波)
[关键词]颈部;皱纹;“火鸡颈”;皮瓣紧缩术;颈后切口;皮瓣张力;瘢痕
[中图分类号]R622 [文献标志码]A [文章编号]1008-6455(2020)10-0078-04
Effect of Skin Flap Constriction Through Posterior Cervical Incision for Correction of “Turkey Neck”
ZOU Yu-chao1，ZOU Yu-mei1，WAN Xing-bo2
(1.Zou Yuchao Medical Beauty Clinic，Dongan District，Mudanjiang City，Mudanjiang 157005，Heilongjiang，China;2.Department of Surgery， Jidong County Maternal and Child Health Hospital， Ji`xi 158200，Heilongjiang，China)
Abstract： Objective To develop a safe， simple and lasting surgical method for the treatment of severe wrinkles in the neck. Methods The elastic and plastic creep characteristics of the skin flap tissue and the solid anatomical characteristics of the loose rear in the front of the neck were used. The posterior incision of the neck was designed， and the loose skin flap tissue was removed as much as possible through deep tension-reducing suture， resulting in lasting tension stimulation to fibroblasts and improved cell nutrition， so that the wrinkle area returned to a younger physiological and appearance state. Results In 9 patients with severe neck wrinkles， the wrinkles disappeared or reduced by more than 2 grades. 7 cases were satisfied and 2 cases were basically satisfied. Conclusion Posterior cervical incision skin flap tightening is a safe， simple and long-lasting operation for the treatment of severe neck wrinkles without incision scar in front of the neck.
Key words： neck; wrinkles; “turkey neck”; skin flap tightening; posterior cervical incision; flap tension; scar
当今面部及五官整形除皱手术发展迅速，手术方式多种多样，技术成熟效果显著，唯独脖颈部位，缺少简单易行同时效果显著持久的技术，而脖颈部位于人体正面显著又难以掩盖的部位，特别在夏季和温热带地区，对于面部和五官都可以进行很好地美容修饰，唯独脖颈部皱纹难以通过美容整形解决，对爱美人士是一件难以接受的事情，对演艺明星则影响其艺术事业发展。从2011年以来特别关注和研究了脖颈部的美容整形手术的问题，并分别以皱纹及皮瓣松弛的轻重划分为四级，给予不同的治疗方法，特别是三～四级，皮瓣最严重松弛和皱纹密集难以解决的俗称“火鸡颈”，采用颈前无切口瘢痕的颈部后方皮瓣紧缩术，除皱效果显著持久。
1 资料和方法
1.1 病例资料：收集2011年-2019年笔者医院收治的9例患者，全部为女性，年龄53～68岁，均为三～四级皱纹，皱紋已经持续多年并逐渐加重，都曾经咨询多地整形医院，未接受全面-颈部除皱手术，愿意接受本手术方式和颈部后方遗留永久瘢痕。一次手术者4例，5例于第一次术后4～9个月行二次手术，随访4～15个月，平均随访9个月。
1.2 颈部皱纹分级：现有的颈部皱纹分级方法涵盖的皱纹范围不足，没有对严重的皱纹和皮瓣松垂分级，为了方便治疗方案的选择，本次按照下列程度分为四级：①一级：横行较深皱纹1～2条或皮下脂肪萎缩皮瓣松弛，两手指可将皮瓣捏起的高度小于1cm;②二级：横行较深的3条皱纹或皮下脂肪萎缩皮瓣松弛，两手指可将皮瓣捏起的高度大于1cm小于2cm;③三级：横行皱纹4条或皮下脂肪萎缩皮瓣松弛，两手指捏起皮瓣的高度大于2cm小于3cm，或出现持久存在的纵向突出的皮瓣条，或者出现网状皱纹;④四级：横行皱纹5条以上或皮下脂肪萎缩，两手指捏起皮瓣的高度大于3cm，或出现持久存在的纵向突出皮瓣条两条以上或持久的纵向皮瓣条高度超过1cm或面积大且深在的网状皱纹。, 百拇医药(邹毓超 邹毓美 万兴波)