Gonzalez Raul
Aesthet Surg J. 2006 Sep-Oct;26(5):537-50. doi: 10.1016/j.asj.2006.08.007.
The buttocks can be affected by many different kinds of retractile notches, all of them caused by histologic alterations of the subcutaneous tissues, gluteal fascia, or muscle at different levels of severity. Until now, no attempt has been made to systemize the diagnosis of these defects or to describe a treatment approach from the aesthetic viewpoint.
We present a definition and a classification of gluteal retractions based on the anatomic structures affected, the assessment used to identify each type of defect, and the techniques used to correct different problems.
The affected muscle fibers or fibrous fascial segments were lysed and removed through an incision on the intergluteal crease, under epidural block. Subcutaneous defects were treated percutaneously by fat grafting and fiber lysis and addressed under local anesthesia or epidural anesthesia when combined with correction of a muscular or fascial retraction.
Treatment results in a series of 214 patients were satisfactory. Complications included seroma in 2 cases of fascial fibrosis, 1 of which was followed by infection; residual inelastic muscle fibers in 2 cases; overcorrection in 8 cases; and infection in 1 case of fat grafting. In 31.2% of patients with subcutaneous defects, more than one fat grafting session was required to correct subcutaneous defects.
The classification system and algorithm based on physical examination presented here for the treatment of gluteal retractions have been shown to be useful tools for diagnosis and treatment of specific types of defects.
臀部可受到多种不同类型的凹陷影响，所有这些凹陷均由皮下组织、臀筋膜或不同严重程度的肌肉在组织学上的改变引起。到目前为止，尚未有人尝试对这些缺陷的诊断进行系统化，也未从美学角度描述治疗方法。
我们基于受影响的解剖结构、用于识别每种缺陷类型的评估方法以及用于纠正不同问题的技术，提出了臀凹陷的定义和分类。
在硬膜外阻滞下，通过臀沟处的切口对受影响的肌纤维或纤维筋膜段进行松解和切除。皮下缺陷通过脂肪移植和纤维溶解进行经皮治疗，当与肌肉或筋膜凹陷的矫正相结合时，在局部麻醉或硬膜外麻醉下进行处理。
214例患者的治疗结果令人满意。并发症包括2例筋膜纤维化出现血清肿，其中1例继发感染；2例残留无弹性肌纤维；8例矫正过度；1例脂肪移植出现感染。在31.2%的皮下缺陷患者中，需要进行不止一次脂肪移植来矫正皮下缺陷。
这里提出的基于体格检查的臀凹陷治疗分类系统和算法已被证明是诊断和治疗特定类型缺陷的有用工具。
