Tiourin Ekaterina, Barton Natalie, Janis Jeffrey E
University of California, Irvine School of Medicine, Irvine, Calif.
Department of Plastic Surgery, University of California, Irvine Medical Center, Orange, Calif.
Plast Reconstr Surg Glob Open. 2021 Aug 12;9(8):e3765. doi: 10.1097/GOX.0000000000003765. eCollection 2021 Aug.
Bleeding and hematoma remain leading causes of postoperative complications and unsatisfactory patient outcomes in facelift surgery. Several methods have been implemented, and continue to be developed, to minimize bleeding in facelift surgery. These methods include perioperative blood pressure management, compression dressings, drains, tissue sealants, wetting solution infiltrate, and tranexamic acid.
An evidence-based review of methods used to minimize bleeding in facelift surgery was conducted using the PubMed database according to PRISMA guidelines. Included studies were evaluated for the effects of implemented methods on bleeding outcomes in facelift surgery. Recommendations for each method evaluated were determined based on the amount, level, and heterogeneity of included studies.
Thirty-six studies were included in the evidence-based review. Effective strategies to reduce the time to hemostasis, postoperative drainage volume, and hematoma rate included perioperative blood pressure management, tissue sealants, and tranexamic acid. While the use of drains or wetting solution infiltrate did not demonstrate to significantly influence bleeding outcome measures, these methods may provide other advantages to facelift surgery. Compression dressings have not demonstrated a significant effect on facelift outcome measures.
Perioperative medical management of blood pressure, tissue sealants, and tranexamic acid are most effective in facilitating hemostasis and preventing postoperative hematoma in facelift surgery.
出血和血肿仍然是面部提升手术术后并发症和患者预后不理想的主要原因。为尽量减少面部提升手术中的出血，已实施并不断开发了多种方法。这些方法包括围手术期血压管理、加压敷料、引流管、组织密封剂、浸润液和氨甲环酸。
根据PRISMA指南，使用PubMed数据库对面部提升手术中用于尽量减少出血的方法进行循证综述。对纳入研究评估所实施方法对面部提升手术出血结果的影响。根据纳入研究的数量、水平和异质性，确定对每种评估方法的建议。
循证综述纳入了36项研究。减少止血时间、术后引流量和血肿发生率的有效策略包括围手术期血压管理、组织密封剂和氨甲环酸。虽然使用引流管或浸润液并未显示对出血结果指标有显著影响，但这些方法可能为面部提升手术带来其他益处。加压敷料对面部提升结果指标未显示出显著影响。
围手术期血压管理、组织密封剂和氨甲环酸在促进面部提升手术止血和预防术后血肿方面最有效。
