张卓 舒茂国 余学元

[摘要]目的：探讨改良发际内切口在额部脂肪瘤切除术中的临床应用效果。方法：选取2017年7月-2020年1月在笔者科室就诊的额部脂肪瘤患者40例，所有患者均采用改良发际内切口实施额部脂肪瘤切除手术。术中沿设计好的发际内切口横向切开皮肤至皮下组织，再沿额肌方向纵向分离帽状腱膜（额肌），然后沿帽状腱膜（额肌）下间隙钝性分离达瘤体周围将脂肪瘤完整取出。术后随访3个月以上，观察患者伤口愈合、美容效果等情况。结果：40例脂肪瘤均完整切除，一期愈合，早期无伤口周围血管及神经损伤而带来的并发症，额部病灶周围及发际内切口愈合后对面部美观无影响。结论：改良发际内切口及相关手术技巧是一种简单实用，创伤较小，美容效果良好的额部脂肪瘤切除术式，值得临床推广应用。

[关键词]发际内切口;额部;脂肪瘤;微创手术;帽状腱膜下;神经血管束

[中图分类号]R739.5    [文献标志码]A    [文章编号]1008-6455（2021）06-0001-04

Applications of a Modified Inter-hairline Incision in the Surgical Removal of Frontal Lipoma

ZHANG Zhuo，SHU Mao-guo，YU Xue-yuan

（Department of Plastic and Cosmetic Maxillofacial Surgery，the First Affiliated Hospital of Xi'an Jiaotong University，Xian 710000，Shaanxi，China）

Abstract： Objective  To explore the clinical applications of a modified inter-hairline incision to surgically remove frontal lipoma. Methods  We included 40 patients with frontal lipoma treated in our department from July 2017 to January 2020. The frontal lipomas in all patients were surgically removed through modified inter-hairline incisions. During the operation， we transversely incised the skin along the designated inter-hairline incision to the subcutaneous tissue. We then longitudinally separated the galea aponeurotica， present over the frontalis muscle， in the direction of the frontalis. Subsequently， to completely remove the lipoma， a blunt dissection was performed along the inferior space of the galea aponeurotica to the periphery of the lipoma. The patients were monitored for >3 months after the operation to observe wound healing and cosmetic effects. Results  The 40 lipomas were excised completely. All incisions healed by first intention. No complications caused by injury to the peripheral blood vessel and nerve occurred in the early stage of healing. In addition， the facial appearances of the patients were not affected after the incisions around the frontal lesions and in the hairline had healed. Conclusion  The modified inter-hairline incision with relevant operative technique is a simple， practical and less-invasive surgical modality for the resection of frontal lipomas with favourable cosmetic effects. This protocol is worthy of being applied and popularised in clinical settings.

Key words： inter-hairline incision; frontal region; lipoma; minimally invasive operation; sub-galeal; nerve-vessel bundle

脂肪瘤是一種最常见的皮肤良性软组织肿瘤，由成熟脂肪细胞组成，好发于躯干，如肩背、颈项、乳房和臀部，其次为头面部。大多数脂肪瘤仅表现为局部肿块，并不导致功能问题。所以很多患者是为了解除外观影响决定手术切除脂肪瘤，尤其是脂肪瘤长在面部的患者。头面部脂肪瘤以额部者居多，额部平滑辽阔，而局部的隆起通常会比较明显，影响患者外观，因此额部脂肪瘤一般具有明确的手术切除指征和需求。传统手术采用肿物表面顺皮纹切口，存在遗留继发性瘢痕的风险。随……