Zoumalan Richard, Rizk Samieh S
Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Lenox Hill-Manhattan Eye, Ear, and Throat Hospital, NY, NY, USA.
Arch Facial Plast Surg. 2008 Mar-Apr;10(2):103-7. doi: 10.1001/archfaci.10.2.103.
To determine the rate of hematoma formation in drainless deep-plane rhytidectomy and compare it with the rate using the same technique with the use of fibrin glue.
This is a retrospective review of 605 patients (78 male and 527 female) who, over a 6-year period, underwent deep-plane face-lift surgery (n = 544) or lateral superficial musculoaponeurotic system (SMAS)ectomy (n = 61) by the senior author (S.S.R.) without the use of surgical drains. One hundred forty-six consecutive patients underwent rhytidectomy without fibrin tissue glue, and the following 459 consecutive patients were sprayed with fibrin glue under the flap prior to flap closure. Pressure dressings were used on all patients for 24 hours.
None of the patients in either group had major or expanding hematomas requiring operative intervention. In the group of patients treated without fibrin glue (n = 146), there were 5 minor, nonexpanding hematomas, all managed by needle aspiration. This is a minor hematoma rate of 3.4%. In the fibrin glue group (n = 459), there were 2 hematomas, for a rate of 0.4%. Using a Fisher exact test, we found a statistically significant decrease in the hematoma rate from 3.4% to 0.4% (P = .01). Male patients had a higher hematoma rate than female patients, and only men had significantly fewer hematomas when fibrin glue was applied (P = .01). All 7 hematomas were recognized in the first 24 hours after surgery. Of the 7 patients with hematomas, 2 (29%) had emesis in the recovery room despite medication.
The use of fibrin glue demonstrates a significant decrease in the rate of hematoma formation. Fibrin glue may benefit male more than female patients. If meticulous hemostasis and pressure dressings are used, drains are not necessary. The prevention and prompt treatment of postoperative nausea may also help prevent hematoma formation.
确定无引流深层平面除皱术中血肿形成的发生率，并将其与使用相同技术并应用纤维蛋白胶时的发生率进行比较。
这是一项对605例患者（78例男性和527例女性）的回顾性研究，这些患者在6年期间接受了资深作者（S.S.R.）进行的深层平面面部提升手术（n = 544）或外侧表浅肌肉腱膜系统（SMAS）切除术（n = 61），术中未使用手术引流管。146例连续患者接受了未使用纤维蛋白组织胶的除皱术，随后的459例连续患者在皮瓣闭合前在皮瓣下喷洒了纤维蛋白胶。所有患者均使用压力敷料24小时。
两组患者均无需要手术干预的重大或扩大性血肿。在未使用纤维蛋白胶治疗的患者组（n = 146）中，有5例小的、非扩大性血肿，均通过针吸处理。这是一个3.4%的小血肿发生率。在纤维蛋白胶组（n = 459）中，有2例血肿，发生率为0.4%。使用Fisher精确检验，我们发现血肿发生率从3.4%显著降低至0.4%（P = 0.01）。男性患者的血肿发生率高于女性患者，并且仅在应用纤维蛋白胶时男性的血肿明显减少（P = 0.01）。所有7例血肿均在术后24小时内被发现。在7例有血肿的患者中，2例（29%）尽管用药但在恢复室仍有呕吐。
使用纤维蛋白胶可显著降低血肿形成的发生率。纤维蛋白胶对男性患者的益处可能大于女性患者。如果采用细致的止血和压力敷料，则无需引流管。术后恶心的预防和及时治疗也可能有助于预防血肿形成。
