Schnur P L, Weinzweig J
Division of Plastic and Reconstructive Surgery, Mayo Clinic Scottsdale, Ariz, USA.
Plast Reconstr Surg. 1995 Dec;96(7):1724-6. doi: 10.1097/00006534-199512000-00033.
Hematoma remains a problematic complication of face lift surgery. Sequelae of hematomas may include temporary skin irregularities, a prolonged postoperative recovery period, skin necrosis, and a compromised final result. Attempts to maximize intraoperative and postoperative hemostasis and thus prevent postoperative hematoma formation have focused on the use of local anesthetics with epinephrine modifications, topical thrombin, bed rest, blood pressure control, local anesthetics with intravenous sedation rather than general anesthesia, and the use of the "second-look" technique popularized 30 years ago. When initially practiced by the senior author, the second-look technique resulted in a dramatic decrease in the incidence of hematoma formation from 21.7 to 6.7 percent. It was concluded at that time that the second-look technique was responsible for the reduced incidence of this face lift complication. However, the present series of 82 face lifts performed using a modification of the original Marcaine/epinephrine infiltration technique without the second-look technique demonstrates an overall incidence of hematoma formation of 7.3 percent. These results demonstrate no advantage of the second-look technique over the traditional technique when epinephrine is infiltrated in the fashion described and meticulous hemostasis is obtained.
血肿仍然是面部提升手术中一个棘手的并发症。血肿的后遗症可能包括暂时性皮肤不平整、术后恢复期延长、皮肤坏死以及最终效果受损。为了最大限度地减少术中及术后出血并预防术后血肿形成，人们尝试了多种方法，包括使用含肾上腺素改良剂的局部麻醉药、局部应用凝血酶、卧床休息、控制血压、采用局部麻醉加静脉镇静而非全身麻醉，以及运用30年前推广的“二次探查”技术。当初级作者最初实施该技术时，二次探查技术使血肿形成的发生率从21.7%大幅降至6.7%。当时得出的结论是，二次探查技术是导致这种面部提升并发症发生率降低的原因。然而，目前这组82例面部提升手术采用了改良的原甲哌卡因/肾上腺素浸润技术，未使用二次探查技术，血肿形成的总体发生率为7.3%。这些结果表明，当按照所述方式浸润肾上腺素并实现细致止血时，二次探查技术相较于传统技术并无优势。
