Burgess L P, Casler J D, Kryzer T C
Otolaryngology-Head and Neck Surgery Service, Walter Reed Army Medical Center, Washington, DC.
Arch Otolaryngol Head Neck Surg. 1993 Feb;119(2):173-6; discussion 176-7. doi: 10.1001/archotol.1993.01880140055010.
This study was conducted to determine the effects of skin-flap undermining and superficial musculoaponeurotic system (SMAS) suspension on wound-closing tension. Nine sides from five fresh-frozen cadavers were used, with closing tension measured at the two main anchor points, anteriorly (A) and posteriorly (P), with and without SMAS plication for minimal (MIN), intermediate (INT), and maximal (MAX) skin-flap undermining. Results indicated that closing tension was significantly decreased with SMAS plication, both A and P, for all three levels of skin undermining. The average decrease in closing tension with SMAS plication was: A-MIN 191 g, A-INT 95 g, A-MAX 83 g, P-MIN 235 g, P-INT 68 g, and P-MAX 70 g (P < .001 for all). Considering the effect of skin-flap undermining alone, closing tension decreased with wider skin-flap undermining, both with and without SMAS plication. The tension-reducing effect of SMAS plication was decreased with wider skin-flap undermining. Regression analysis determined a second-order exponential curve relating closing tension to skin excision.
本研究旨在确定皮瓣潜行分离和浅表肌肉腱膜系统（SMAS）悬吊对伤口闭合张力的影响。使用了来自5具新鲜冷冻尸体的9个侧面，在有和没有SMAS折叠的情况下，于两个主要锚定点（前方（A）和后方（P））测量最小（MIN）、中度（INT）和最大（MAX）皮瓣潜行分离时的闭合张力。结果表明，对于所有三个皮瓣潜行分离水平，SMAS折叠均显著降低了A和P处的闭合张力。SMAS折叠导致的闭合张力平均降低幅度为：A-MIN 191 g，A-INT 95 g，A-MAX 83 g，P-MIN 235 g，P-INT 68 g，P-MAX 70 g（所有P值均<0.001）。仅考虑皮瓣潜行分离的影响，无论有无SMAS折叠，闭合张力均随皮瓣潜行分离范围扩大而降低。随着皮瓣潜行分离范围扩大，SMAS折叠的张力降低效果减弱。回归分析确定了一条将闭合张力与皮肤切除相关联的二阶指数曲线。
