Objective:To investigate the clinical effect of the subbrow blepharoplasty by fixing and folding inward the orbicularis oculi muscle in a single point to improve the upper eyelid skin laxity.Methods:From May 2016 to February 2019, 109 patients (16 males and 93 females)underwent subbrow blepharoplasty combined with single point orbicularis oculi muscle fixing and folding (SBB-soff)in the Outpatient Department of Plastic Surgery Northern Jiangsu People’s Hospital. During the operation, the spindle skin below the eyebrow was excised, and the orbicularis oculi muscle (OOM) was retained. Then we made a small incision at the supraorbital rim, deep down to the periosteum. The OOM was folded inward and fixed on the periosteum in a single point through this small incision. The effect of the operation was evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs.The height margins of the upper eyelids and eyebrow position were evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs (use the iris diameter as one unit). Repeated measures t test was used for analyzing normal distribution data, the non-parametric Wilcoxon test was used for statistical analysis of abnormal distribution data, and P<0.05 was considered to be statistically significant. Results:The incisions of all the 109 cases had primary healing. The postoperative follow-up period averaged a period of (9.57±6.13)months (3 months to 3 years). 85.3% of patients (93 of 109) were followed up for more than 6 months. The subjective questionnaire survey showed that patients’ satisfaction rate was 99.1% (108 of 109) at one month postoperatively, and there were no serious postoperative complications in the sensory function of the forehead, the motor function of eyebrows and upper eyelids, etc.The upper eyelid margins at the sites above the mid pupil points elevated from (0.466±0.149) units to(0.600±0.126) units ( t=-16.186, P<0.001). The upper eyelid margins at the sites above the lateral limbus elevated from(0.387±0.156)units to (0.568±0.166) units ( t=-31.882, P<0.001). The upper eyelid margins at the sites above the lateral canthus elevated from (0.214±0.087) units to (0.446±0.098) units ( t=-49.332, P<0.001). In addition, all the differences were statistically significant.A total of 86 patients were followed up for 6 months without intraoperative eyebrow position adjustment. The data from each measuring point of the statistical baseline to the inferior edge of the eyebrow showed that the eyebrow height at 6 months postoperatively descended slightly, but the difference was not statistically significant ( P>0.05). The periodic appearance and function were significantly improved after the operation. Conclusions:SBB-soff can improve the dermatochalasis and aging signs of the upper eyelid tissue and make no negative effects on the position of eyebrows. In addition, it has the advantages of uncomplicated operation, less trauma, and persistent effect.

Objective:To investigate the clinical effect of the subbrow blepharoplasty by fixing and folding inward the orbicularis oculi muscle in a single point to improve the upper eyelid skin laxity.Methods:From May 2016 to February 2019, 109 patients (16 males and 93 females)underwent subbrow blepharoplasty combined with single point orbicularis oculi muscle fixing and folding (SBB-soff)in the Outpatient Department of Plastic Surgery Northern Jiangsu People’s Hospital. During the operation, the spindle skin below the eyebrow was excised, and the orbicularis oculi muscle (OOM) was retained. Then we made a small incision at the supraorbital rim, deep down to the periosteum. The OOM was folded inward and fixed on the periosteum in a single point through this small incision. The effect of the operation was evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs.The height margins of the upper eyelids and eyebrow position were evaluated by a questionnaire survey and statistical analysis of preoperative and postoperative photographs (use the iris diameter as one unit). Repeated measures t test was used for analyzing normal distribution data, the non-parametric Wilcoxon test was used for statistical analysis of abnormal distribution data, and P<0.05 was considered to be statistically significant. Results:The incisions of all the 109 cases had primary healing. The postoperative follow-up period averaged a period of (9.57±6.13)months (3 months to 3 years). 85.3% of patients (93 of 109) were followed up for more than 6 months. The subjective questionnaire survey showed that patients’ satisfaction rate was 99.1% (108 of 109) at one month postoperatively, and there were no serious postoperative complications in the sensory function of the forehead, the motor function of eyebrows and upper eyelids, etc.The upper eyelid margins at the sites above the mid pupil points elevated from (0.466±0.149) units to(0.600±0.126) units ( t=-16.186, P<0.001). The upper eyelid margins at the sites above the lateral limbus elevated from(0.387±0.156)units to (0.568±0.166) units ( t=-31.882, P<0.001). The upper eyelid margins at the sites above the lateral canthus elevated from (0.214±0.087) units to (0.446±0.098) units ( t=-49.332, P<0.001). In addition, all the differences were statistically significant.A total of 86 patients were followed up for 6 months without intraoperative eyebrow position adjustment. The data from each measuring point of the statistical baseline to the inferior edge of the eyebrow showed that the eyebrow height at 6 months postoperatively descended slightly, but the difference was not statistically significant ( P>0.05). The periodic appearance and function were significantly improved after the operation. Conclusions:SBB-soff can improve the dermatochalasis and aging signs of the upper eyelid tissue and make no negative effects on the position of eyebrows. In addition, it has the advantages of uncomplicated operation, less trauma, and persistent effect.

Objective:To systematically evaluate the safety and efficacy of dexmedetomidine combined with ketamine during dressing changes in burn patients using meta-analysis.Methods:Foreign language databases including PubMed, Cochrane Central, Embase, and Web of Science were searched with the terms of " burns, dexmedetomidine, ketamine, and dressing" , and Chinese databases including Chinese Journal Full-Text Database, Wanfang Data, and China Academic Journal Network Publishing Database were searched with the terms in Chinese version of "右美托咪定,氯胺酮,烧伤,烫伤,热力伤,换药" to retrieve the publicly published randomized controlled trials on the application of dexmedetomidine combined with ketamine for sedation and analgesia during dressing changes in burn patients from the establishment of each database to March 2019. The outcome indexes included systolic blood pressure at 5 minutes after administration, arousal restlessness score, ketamine dosage, dressing change time, body movement/recovery time, pain score, Ramsay sedation scores at 10 minutes after the start of dressing change and 1 hour after dressing change, physician satisfaction score, neuropsychological symptoms, nausea and vomiting times, nausea and vomiting score. RevMan 5.3 and Stata 14.0 statistical software were used to conduct a meta-analysis of eligible studies.Results:A total of 396 burn patients were included in 7 articles, including 198 patients in dexmedetomidine+ ketamine group who received dexmedetomidine and ketamine for sedation and analgesia, and 198 patients in ketamine alone group who received ketamine alone for sedation and analgesia. The bias risks of the seven studies included were uncertain. Compared with those of ketamine alone group, the systolic blood pressure at 5 minutes after administration, arousal restlessness score, nausea and vomiting score of patients in dexmedetomidine+ ketamine group were significantly decreased, with standardized mean differences of -13.89, -0.84, and -0.99 (95% confidence interval=-20.89--6.89, -1.17--0.52, -1.31--0.68, P<0.01), the Ramsay sedation score at 10 minutes after the start of dressing change and that at 1 hour after dressing change were significantly increased, with standardized mean differences of 1.53 and 0.72 (95% confidence interval=1.05-2.02, 0.13-1.31, P<0.05 or P<0.01), and the number of neuropsychological symptom and number of nausea and vomiting were significantly reduced, with relative risks of 0.20 and 0.16 (95% confidence interval=0.07-0.58, 0.05-0.58, P<0.01). The patients in the two groups were similar in ketamine dosage, dressing change time, body movement/recovery time, pain score, and physician satisfaction score. There was no publication bias in dressing change time or ketamine dosage ( P>0.05), while the other indexes might have publication bias ( P<0.05). Conclusions:Compared with ketamine alone, combination of dexmedetomidine and ketamine during dressing changes in burn patients can reduce the occurrence of restlessness, nausea and vomiting, neuropsychological symptoms, and other complications, better stabilize blood pressure, and enhance sedation effect.

Heterotopic ossification is a rare complication of burns, and its incidence and risk factors are still unclear. Through summarizing the literature on heterotopic ossification caused by burns at home and abroad, the author searched for the risk factors of heterotopic ossification after burn and the new progress of its prevention and treatment. It was realized that the size, depth and healing time of burn wounds were related to heterotopic ossification; the nonsteroidal anti-inflammatory drugs, radiation therapy, and their combination therapy can be used for the prevention of heterotopic ossification; surgery is an effective means of treating heterotopic ossification.