Bass L S
Institute of Reconstructive Plastic Surgery, NYU Medical Center, Department of Plastic Surgery, Manhattan Eye Ear & Throat Hospital, New York, NY, USA.
Ann Plast Surg. 1998 Apr;40(4):335-42. doi: 10.1097/00000637-199804000-00003.
An ongoing goal of aesthetic surgery is a reduction in complications and an improvement in reproducibility and speed. Balloon dissector devices have been used in other areas of surgery to achieve these goals. This report presents early clinical experience using a balloon dissector to elevate the skin flap in facialplasty. The first step in the technique is the creation of a tunnel from a small preauricular incision toward the oral commissure using scissors dissection. The balloon device is inserted into this tunnel and inflated. Unrolling the device elevates the skin flap in the cheek and neck area. Retroauricular dissection and final adjustment of flap size and shape is completed sharply. Subsequent superficial musculoaponeurotic system flap development, skin redraping, and closure is performed in a conventional fashion after customary facialplasty incisions are made. Comparison of complications, postoperative drainage, and time required for dissection and for hemostasis was made between a balloon-dissected side and a conventionally dissected side in 10 patients undergoing facialplasty. Ten additional patients were treated with balloon dissection bilaterally. Patients ranged in age from 45 to 73 years. Mean balloon dissection time was 1.4 minutes (range, 0.75-4 minutes). This produced an even flap thickness in the correct plane with few if any bleeding points. Mean total dissection time on the balloon side was significantly shorter-13.6 minutes-compared with 27.8 minutes (p < 0.003) on the conventional side. Mean difference in time to hemostasis between conventional and balloon sides was 3.8 minutes (p < 0.001). Mean total postoperative drainage (all drains removed at 24 hours) was 13.8 cc on the balloon side and 18.8 cc on the conventional side (not significant, p=0.08). Less ecchymosis and swelling was observed on the balloon side compared with the scissors-dissected side. There were no skin losses, hematomas, infections, or nerve injuries on either side. Appearance of skin redraping was comparable on each side in all patients. Balloon dissection represents a promising alternative means of creating rapid, reproducible skin flap elevation in facialplasty, and is associated with a minimum of bleeding, ecchymosis, and swelling.
美容外科的一个长期目标是减少并发症，提高可重复性和手术速度。球囊分离器装置已在其他外科领域中使用以实现这些目标。本报告介绍了使用球囊分离器在面部整形手术中掀起皮瓣的早期临床经验。该技术的第一步是使用剪刀分离从耳前小切口向口角创建一个隧道。将球囊装置插入该隧道并充气。展开该装置可掀起脸颊和颈部区域的皮瓣。耳后分离以及皮瓣大小和形状的最终调整通过锐性分离完成。在进行常规面部整形手术切口后，以传统方式进行后续的浅表肌肉腱膜系统皮瓣展开、皮肤重新铺展和缝合。对10例接受面部整形手术的患者的球囊分离侧和传统分离侧的并发症、术后引流以及分离和止血所需时间进行了比较。另外10例患者双侧接受球囊分离治疗。患者年龄在45至73岁之间。平均球囊分离时间为1.4分钟（范围为0.75 - 4分钟）。这在正确的平面上产生了均匀的皮瓣厚度，几乎没有出血点。球囊侧的平均总分离时间明显更短，为13.6分钟，而传统侧为27.8分钟（p < 0.003）。传统侧和球囊侧止血时间的平均差异为3.8分钟（p < 0.001）。球囊侧术后总引流量（所有引流管在24小时拔除）平均为13.8 cc，传统侧为18.8 cc（无统计学意义，p = 0.08）。与剪刀分离侧相比，球囊侧观察到的瘀斑和肿胀更少。两侧均未出现皮肤损失、血肿、感染或神经损伤。所有患者两侧皮肤重新铺展的外观相当。球囊分离是在面部整形手术中快速、可重复掀起皮瓣的一种有前景的替代方法，并且出血、瘀斑和肿胀最少。
