, Alameda Presidente Taunay, 1756, Curitiba, Paraná, 80430-000, Brazil.
Aesthetic Plast Surg. 2014 Feb;38(1):1-9. doi: 10.1007/s00266-013-0202-5. Epub 2013 Aug 16.
Hematoma is the most common postoperative complication of rhytidoplasty, resulting in higher morbidity and longer recovery. Quilting suture for closure of the undermined area in abdominoplasty avoids the occurrence of seroma. Based on this principle and with the objective of reducing the number of patients with hematomas in rhytidoplasty, a similar surgical tactic was developed in which a hemostatic net is created with a running transfixing suture of 5-0 nylon encompassing the skin and the superficial musculoaponeurotic system-platysma.
The study enrolled 525 consecutive patients who underwent rhytidoplasty between July 2009 and February 2013. The first 120 patients (group A) were evaluated retrospectively and considered control subjects. The remaining 405 patients (group B) had application of the described tactic, with data collected prospectively. The occurrence of hematoma, ischemia, and necrosis was observed during the first 72 h after surgery.
Control group A included 17 patients with hematoma (14.2 %) during the first 72 h, whereas no patient in group B experienced such a complication (p < 0.001). The surgical tactic did not significantly increase the occurrence of ischemia. This complication was experienced by 11 patients in group A (9.2 %) and 26 patients in group B (6.4 %) (p = 0.408). The tactic also did not change the incidence of necrosis, which was present in three group A patients (2.5 %) and six group B patients (1.5 %) (p = 0.723).
The hemostatic net is an efficient and safe method for preventing early hematomas in rhytidoplasties. LEVEL OF EVIDENCE III This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
血肿是除皱术中最常见的术后并发症，导致发病率更高，恢复期更长。在腹部整形术中，对皮下潜行区进行缝合时使用褥式缝线可以避免血清肿的发生。基于这一原理，并为了减少除皱术中血肿患者的数量，我们开发了一种类似的手术策略，即用 5-0 尼龙连续贯穿缝线在皮肤和浅层肌肉筋膜系统-颈阔肌之间形成一个止血网。
这项研究纳入了 2009 年 7 月至 2013 年 2 月期间接受除皱术的 525 例连续患者。前 120 例患者（A 组）为回顾性评估，作为对照组。其余 405 例患者（B 组）采用了上述策略，前瞻性收集数据。观察术后 72 小时内血肿、缺血和坏死的发生情况。
A 组在术后 72 小时内有 17 例（14.2%）出现血肿，而 B 组无患者出现这种并发症（p<0.001）。该手术策略并未显著增加缺血的发生。A 组有 11 例（9.2%）和 B 组有 26 例（6.4%）发生这种并发症（p=0.408）。该策略也未改变坏死的发生率，A 组有 3 例（2.5%）和 B 组有 6 例（1.5%）出现坏死（p=0.723）。
止血网是预防除皱术中早期血肿的有效且安全的方法。
证据等级 III 本杂志要求作者为每篇文章分配一个证据等级。如需更详细了解这些循证医学等级，请参考目录或在线作者指南 www.springer.com/00266 。
