The scope of plastic surgery includes six kinds of diseases, namely: 1. Early and late stages of trauma and burns; 2. Congenital malformation; 3. Body surface tumor; 4. Inflammation and its sequelae; 5. Beauty; 6. Psychotherapy refers to the application of plastic surgery to treat "defects and deformities" in a certain part of the body, thus eliminating the paranoia of patients.
Plastic surgeons have "three enemies", full-thickness defect, straight line and wound tension.
Plastic surgeons should master flexible and diverse plastic techniques and techniques, not stick to one method and apply it everywhere, because there is no uniform routine for plastic surgery, and they should analyze specific cases and not stick to stereotypes. You will often encounter unfamiliar problems and unheard-of operations. At this time, it is necessary to avoid imposing a surgical method on patients with traditional habits and fixed concepts. When the surgical plan is still uncertain, placement is the best method. After studying, discussing and thinking, the best scheme will always come to mind.
A French philosopher once said that a really smart person is a person who can hold two different views in his mind at the same time. For methods, we should break the feudal pedantic concept of loyalty to the whole. People who are good at solving problems always keep the necessary choices for themselves between different methods and always rebuild their ideas. Therefore, plastic surgeons should be good at predicting, controlling and reducing suture tension.
The application of minimally invasive scalpel therapy in the field of plastic and cosmetic surgery has the following aspects:
Linear scar contracture is the main one, with layers in and under dermis and surface fat; Keloid-mechanical changes in keloids: tensile stress, compressive stress and tensile stress; Three-dimensional release operation of keloid: determine the center point: minimally invasive scalpel is inserted into the center in all directions around keloid; Release between keloid and normal skin; Facial wrinkles-facial myodegeneration: the original elasticity of muscle fibers decreases, showing fibrosis contracture and increased pressure.
Treatment of cord-like scar contracture with needle knife
1. Overview
Striated scar contracture is a common clinical disease in plastic surgery, which is more common after burn, trauma and surgical incision, especially after straight incision healing. Can be located in all parts of the body, easy to stretch and bend around the neck and joints.
2. About anatomy
The human body is wrapped by skin and soft tissue, from shallow to deep, it is keratinized layer, epidermis, dermis, subcutaneous loose connective tissue and fat layer in turn. The damage of cord scar contracture occurs in dermis.
3. Pathological causes
Once the skin is injured, the human body will have a natural and instinctive biological reaction of healing and repair, and its healing and repair mechanism includes two aspects: first, inflammation exudation, cell infiltration, hematoma organization, and fibroblasts become mature fibers; Second, the fiber shrinks, the wound shrinks, and the epidermal cells regenerate and cover the wound, thus completing the healing and repair process. This process itself caused the hypertrophy of local tissue at the wound, and fiber contraction not only caused the hypertrophy of local tissue, but also pulled the surrounding normal soft tissue, resulting in morphological deformity and dysfunction.
4. Clinical manifestations
With the different parts of spinal cord scar, its clinical manifestations are also different. For example, in the neck or joints, it can cause obvious traction deformity and limited flexion and extension activities. Striated scar contracture spanning a long period of time can also lead to secondary bone dysplasia, morphological deformity and facial and limb dysfunction.
The scar on the epidermis is strip or flake, which makes the patient stretch and flex the joint, making the scar in a state of tension, freely pushing the scar horizontally perpendicular to the long axis of the scar, or freely pushing the scar along the long axis of the scar, indicating that there is no adhesion between the scar and the deep tissue, and there is a fat layer in the middle.
The patient's conscious symptoms are: tension and tightness in the part where the cord-like scar is located, and the soft tissue around the neck or joints is sore and uncomfortable, especially in the morning, which is relieved after the activity.
5. Diagnostic basis
Medical history: history of burns, trauma and operation.
Patient's symptoms: generally, you can point out the most nervous and uncomfortable parts with your fingers.
Palpation: judge the thickness, tension, mobility, relationship with deep tissues, adhesion and scar contracture.
6. Basic theory of treatment
The essence of cord-like scar contracture is the defect of skin tissue, and the amount of damaged skin tissue is not particularly large. If skin tissue free transplantation or Z-plasty is used, cord-like scar contracture can be completely corrected, but it is bound to leave obvious scar marks.
The essence of contracture of cord scar is the defect and contracture of dermal tissue, which is caused by the excessive increase of longitudinal internal stress of dermal tissue in cord scar, and its carrier is dermal tissue fiber in scar. As long as the integrity and continuity of epidermis are maintained and the skin is cut and released in sections, the purpose of curing the contracture of cord scar can be achieved.
Step 7 deal with
Once the skin is damaged, it is an important defensive adaptive response to start tissue repair immediately. The process of skin wound healing is usually divided into inflammation exudation stage, cell and matrix proliferation stage-epithelization and granulation tissue formation stage, in which fiber proliferation and wound contraction are very important, and finally tissue remodeling stage. There are many factors that affect the healing process of skin wounds.
7. 1 acupotomy therapy
According to the length, mark the longitudinal axis of scar contracture in centimeters. Make a treatment plan.
The first time: use a needle knife to cut the skin 2 cm away from the contracture scar rope, with the blade perpendicular to the longitudinal axis of the contracture scar rope, and make a full-thickness straight-line incision and release in the contracture dermal scar. The distance between each straight line is 0. 1 cm, and the number of straight lines depends on the scar size. Make several straight-line incision and release at the scar of contracture dermis, with a distance of 0.2 cm. Pay attention to protect the epidermis and don't puncture it.
The second time: repeat the first operation, except that the point of the needle knife outside the skin is between the two points of the first needle knife.
The third time: the performer touches the patient with his hand, and at the same time makes the patient move and cooperate, and releases the contracture with a needle knife where he feels nervous.
Time interval: the time interval of each publishing operation is 2 1 day.
The therapeutic effects of acupotomy on scar include: reducing the strength and fatigue damage of keloid; Destroy the blood circulation in keloid and slow down the growth rate of keloid; Cracks are formed in keloids, which is convenient for drugs to exert pharmacological effects.
7.2 drug therapy
It is better to cooperate with local injection of drugs after the needle knife is released. Generally, the drugs that can be used for injection are: diphenhydramine hydrochloride injection 2%-0 1 ml (20 mg), hyaluronidase injection 1500 unit, Kangning Ke Tong A injection 40 mg, and Debaoson injection 1 ml (7 mg).
Therapeutic effects of various drugs on scars;
Kangning Ketong A or Debaoson injection: inhibit collagen synthesis and promote collagen degradation;
Diphenhydramine injection: inhibit the growth of fibroblasts, resist histamine in scars, and resist allergy;
Hyaluronidase injection: reduce the viscosity of intercellular substance and promote the diffusion and absorption of drugs;
The above drugs can be used alone or in combination. When mixing, evenly use the mixture of diphenhydramine hydrochloride injection 2%-0 1 ml (20 combined milligrams), hyaluronidase injection 1500 units, Corning Ke Tong A injection 40 mg or Debaoson injection. The application method is to dilute the liquid medicine with proper amount of normal saline, divide it into several parts, and evenly inject it into the surgical release site in the scar.
The total amount of drugs should be controlled below 40 mg of diphenhydramine hydrochloride injection, 30,000 units of hyaluronidase injection, 80 mg of Kangning Ke Tong A injection and Debaoson injection 1ml.
7.3 Nursing routine
Children under six years old and female patients with menstrual disorder, breast-feeding or pregnancy were treated with pressure bandaging for strength destruction in scar alone, or with pressure bandaging for strength destruction in scar after three days+diphenhydramine injection 20-40mg+ hyaluronidase injection1500 u+;
Male and female patients with strong constitution and postpartum can inject mixed drugs; Older people with weak constitution can use ordinary simple drugs.
For high mobility and cross-joint scar contracture, the strength can be broken only in the scar perpendicular to the contracture direction, which can be released for 2-3 times.
7.4 signs
Linear scar contracture, cord scar contracture, flat scar contracture with skin defect less than 20%, keloid.