Buckingham Center for Facial Plastic Surgery, Austin, Texas.
JAMA Facial Plast Surg. 2018 Jan 1;20(1):14-18. doi: 10.1001/jamafacial.2017.0644.
Incision placement and design in rhytidectomy is critical for patient satisfaction.
To evaluate the aesthetic outcome of W-plasty vs traditional straight-line (SL) trichophytic closure techniques on posterior occipital hairline scars in rhytidectomy.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective cohort study was conducted at the Buckingham Center for Facial Plastic Surgery. Clinical history and operative reports were reviewed for 46 patients who underwent rhytidectomy (23 using W-plasty and 23 using SL technique) between June 1, 2014 and August 31, 2015. Blinded photographic analysis of 1-year postoperative photographs was performed.
The posterior occipital hairline incision was primarily closed with either a W-plasty or SL trichophytic technique.
Standard photographs of the posterior occipital incision site obtained after the 1-year postoperative mark were reviewed and scored in a blinded fashion by 3 nonphysician medical staff members using a modified Manchester Scar Scale (MSS: from 0 [best possible outcome] to 24 [worst possible outcome]). Interrater reliability was assessed via Cronbach α testing.
There were 23 patients in each group. The W-plasty and SL groups were similar in terms of age (mean [SD] age, 59.6 [6.3] years and 64.1 [7.3] years, respectively), sex (21 [91%] and 21 [91%] women, respectively), race-ethnicity, and absence of risk factors (smoking and diabetes) predisposing to poor wound healing (0 and 0 smoking/diabetes, respectively). Mean (SD) follow-up times for the W-plasty and SL groups were 388 (38.8) and 475 (100.1) days, respectively. No statistical difference was demonstrated in the mean aggregate MSS scores from all evaluators between the W-plasty group and the SL group (reviewer 1: 5.69 vs 5.86, P = .60; reviewer 2: 10.09 vs 9.56, P = .65; and reviewer 3: 5.30 vs 6.17, P = .08). Overall interrater reliability for the MSS scores was 0.56.
Primary W-plasty and SL trichophytic closures in the posterior occipital hairline appear to yield highly acceptable and similar cosmetic outcomes under objective blinded evaluation. These techniques can be used with success to help minimize conspicuous scarring after rhytidectomy.
面部除皱术中的切口位置和设计对于患者满意度至关重要。
评估 W 成形术与传统直线（SL）发迹内 Trichophytic 闭合技术在后枕部发际线上除皱术后的美学效果。
设计、地点和参与者：这是一项在 Buckingham 面部整形外科研究中心进行的回顾性队列研究。对 2014 年 6 月 1 日至 2015 年 8 月 31 日期间接受除皱术（23 例采用 W 成形术，23 例采用 SL 技术）的 46 例患者的临床病史和手术报告进行了回顾。对术后 1 年的照片进行了盲法摄影分析。
主要采用 W 成形术或 SL Trichophytic 技术闭合枕后发际线切口。
采用改良的曼彻斯特瘢痕量表（MSS：0 分[最佳结果]至 24 分[最差结果]）对术后 1 年的枕后切口部位的标准照片进行盲法评分，由 3 名非医师医疗人员进行。评估者间信度通过 Cronbach α 检验进行。
每组各有 23 例患者。W 成形术组和 SL 组在年龄（平均[标准差]年龄，59.6[6.3]岁和 64.1[7.3]岁）、性别（分别为 21[91%]和 21[91%]女性）、种族和无诱发伤口愈合不良的危险因素（吸烟和糖尿病）方面相似（分别为 0 和 0 例吸烟/糖尿病）。W 成形术组和 SL 组的平均（标准差）随访时间分别为 388（38.8）天和 475（100.1）天。所有评估者的 MSS 总分平均值在 W 成形术组和 SL 组之间无统计学差异（评估者 1：5.69 分 vs 5.86 分，P=0.60；评估者 2：10.09 分 vs 9.56 分，P=0.65；评估者 3：5.30 分 vs 6.17 分，P=0.08）。MSS 评分的总体评估者间可靠性为 0.56。
枕后发际内的主要 W 成形术和 SL Trichophytic 闭合术在客观盲法评估下似乎产生了高度可接受且相似的美容效果。这些技术可成功用于帮助最大限度地减少除皱术后明显的瘢痕。
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