From the Duke University Medical Center; and the Dallas Plastic Surgery Institute.
Plast Reconstr Surg. 2021 Jun 1;147(6):1297-1309. doi: 10.1097/PRS.0000000000007943.
Postoperative hematoma remains the most common complication in rhytidectomy, prompting surgeons to use a multitude of adjunctive measures to prevent its occurrence. The goal of this systematic review was to determine which of these measures are supported by strong evidence, and to highlight those that remain unsubstantiated and require further investigation.
A systematic search was performed of the PubMed and Embase databases for English literature from 1975 to March of 2020 containing designated keywords, and focusing specifically on adjunctive measures aimed at preventing hematoma in rhytidectomy. The resultant articles were then systematically screened according to predefined inclusion and exclusion criteria to determine eligibility for inclusion in the study.
The keyword search yielded a total of 2391 articles. Title and abstract screening resulted in 103 articles that were eligible for full-text review. Ultimately, 48 articles met final inclusion criteria. The articles were categorized into their particular mode of intervention: fibrin tissue sealants, perioperative medications (anesthetics, antihypertensives, miscellaneous medications), and intraoperative maneuvers (hemostatic agents, preinfiltration, intraoperative maneuvers, and drains). Nine studies were indexed as evidence Level II and 24 as evidence Level III. The remainder of studies constituted Level IV evidence.
Adjunctive interventions have been borne out of necessity in efforts to reduce postoperative hematoma after rhytidectomy. Although many of these interventions have promising results, the current literature supports the senior author's (R.J.R.) experience that an evidence-based, multimodal approach is ideal to minimize the rates of hematoma after rhytidectomy.
术后血肿仍然是面部除皱术最常见的并发症，促使外科医生使用多种辅助措施来预防其发生。本系统评价的目的是确定哪些措施有强有力的证据支持，并强调那些仍未得到证实且需要进一步研究的措施。
对 1975 年至 2020 年 3 月期间发表的英文文献进行了系统检索，在 PubMed 和 Embase 数据库中使用指定的关键词进行检索，并特别关注旨在预防面部除皱术血肿的辅助措施。然后，根据预先设定的纳入和排除标准，对所得文章进行系统筛选，以确定其纳入研究的资格。
关键词搜索共产生 2391 篇文章。标题和摘要筛选后，有 103 篇文章有资格进行全文审查。最终，有 48 篇文章符合最终纳入标准。这些文章分为特定的干预模式：纤维蛋白组织密封剂、围手术期药物（麻醉剂、降压药、其他药物）和术中操作（止血剂、预浸润、术中操作和引流管）。9 项研究被索引为证据等级 II，24 项为证据等级 III。其余研究构成了证据等级 IV。
在努力减少面部除皱术后血肿方面，辅助干预措施是必要的。尽管这些干预措施中的许多都有很好的效果，但目前的文献支持资深作者（RJR）的经验，即采用基于证据的多模式方法是最小化面部除皱术后血肿发生率的理想方法。
