Eyelid repair with subcutaneous pedicle flaps

Summary A small subcutaneous pedicle flap is described, which is useful in the reconstruction of eyelid defects. Subcutaneous tissue about 5–8 mm in width was left intact at one end of the flap, this served as a pedicle. This type of flap is advantageous in certain cases because the pedicle adjusts more easily to the rotation of the flap. The flap has been used for closure of the defects of the eyelids and lateral canthus in 28 patients. Four cases of lower eyelid and lateral canthal defects repaired with flaps from the zygomatic or temporal region are presented.     

眶区眼轮匝肌蒂岛状皮瓣在眶周皮肤缺损修复中的应用

目的 探讨应用眶区眼轮匝肌蒂岛状皮瓣修复眶周皮肤全层缺损的方法与手术技巧。方法 根据缺损的部位、形态及面积,分别应用以上、下眶区眼轮匝肌内侧为蒂的岛状皮瓣修复眶周的皮肤缺损,供区直接缝合。结果 2003年7月至2009年10月,应用上述方法共修复24例,除l例术后皮瓣远端部分坏死,经换药愈合,2例皮瓣表皮坏死未行处理,自行愈合外,其余皮瓣均成活良好。随访6 ～ 24个月,所有皮瓣色泽、质地均良好,与周围组织无明显差别,供区瘢痕不明显,外形满意。结论选择以眼轮匝肌眶部内侧为蒂的岛状皮瓣一期修复眶周皮肤缺损,血供良好,供区隐蔽,术后效果满意。     

A combined flap reconstruction for full-thickness defects of the medial canthal region.

The medial canthus is an aesthetically and functionally important area. Adequate consideration of the local anatomy is essential when reconstructing this area. We developed a combined flap technique with a simple combination of standard flaps for the treatment of extensive defects of the nose and upper and lower eyelids, including full-thickness medial canthus defect. In our technique, a median forehead island flap is used for the nasal region, the anterior surface of the eyelid is reconstructed along aesthetic unit, and the posterior surface is reconstructed with a palatal mucoperiosteal graft. A cheek flap is then used for the reconstruction of the lower eyelid. When reconstructing a small defect of the upper eyelid, the upper eyelid is advanced, while a V-Y advancement flap within the upper eyelid is used for a large defect. To reconstruct the acute angle of the medial canthus, a 0.3 mm titanium wire was passed through the tip of the tarsal plate of the upper and lower eyelids to be reconstructed and was fixed in the perforated nasal bone on the affected side. Using this technique, the acute angle of the medial canthus is well preserved after surgery, and is located symmetrically with its counterpart on the intact side. Our technique provides good reconstructive results and should serve as a valid alternative for the reconstruction of this area.     

以睑缘动脉弓为蒂的眼睑推进瓣的临床应用

目的探讨眼睑瓣在修复眼睑全层缺损中的应用。方法以睑缘动脉弓为营养血管蒂，在眼睑全层缺损的两侧与缺损底部等高，水平向两侧设计眼睑矩形瓣；若缺损较大，外侧眼睑瓣设计线可绕过眼外眦角（距外眦角0．5cm）延伸到对侧眼睑（上或下眼睑，根据缺损是在下或上眼睑），全层切开后水平向中央缺损区推进，分层缝合修复缺损。结果20例患者应用本法修复，其中眼睑基底细胞癌4例，鳞癌2例，海绵状血管瘤3例，色素痣6例，外伤性缺损3例，先天性眼睑缺损2例。缺损最大水平宽度1．7cm，最小0．7cm。缺损位于上睑6例，下睑14例。所有眼睑瓣均全部成活，修复后的眼睑外形佳，睑缘平滑，睫毛生长正常。结论以睑缘动脉弓为营养血管的眼睑瓣修复眼睑全层缺损是用同类组织修复，手术一次完成，效果良好，且睑缘动脉弓恒定，眼睑瓣血供丰富，是眼睑全层缺损较理想的修复方法。     

Trilobed Skin Flap on the Face: For Reconstruction of Full-Thickness or Commissural Defects

BACKGROUND: Although many local skin flaps have been described for reconstruction of defects on the face, there are still some difficulties in reconstruction of full-thickness defects of alar and ear region and commissural defects in periorbital and perioral region. OBJECTIVE: A trilobed skin flap can offer single-stage reconstruction of difficult full-thickness or commissural defects. We performed trilobed skin flaps in reconstruction of the defects on the face. The design of the flap and outcomes of the procedures are presented. METHODS: Twelve patients with skin cancer on the face were operated under general or local anesthesia. After tumor resection, defects were closed with a trilobed skin flap. Patients were followed-up for a minimum 6 months. RESULTS: There was no early or late complication in all patients. Oral competence was achieved in reconstruction of the oral commissure. A new lateral canthus with angles as in the original one was created. Alar and ear reconstructions were performed at one session using the same flap without a graft. The outcome was satisfactory. CONCLUSION: Because it is easy to obtain a trilobed skin flap, it can be used for reconstruction of canthal, oral, and commissural defects, and the new canthus, mouth, and commissures with angles as in the original ones can be created. In addition, the flap can be used for reconstruction of full-thickness defects in the alar region and the ear.     

眼睑复合组织瓣修复眼睑全层缺损

目的 探讨中、重度眼睑全层缺损的修复方法。方法 根据眼睑的解剖结构设计眼睑缺损两侧以睑缘动脉弓为血供的带蒂眼睑复合组织瓣，切开游离后，向缺损区水平推进I期修复眼睑包括睑缘睫毛在内的全层组织缺损。结果 1998年以来临床治疗11例，眼睑缺损最大长度1．7cm，最小0．8cm，缺损长度均超过全睑长度的1／3，眼睑瓣全部成活，无并发症，修复后眼睑外形满意。结论 应用带蒂眼睑复合组织瓣推进I期修复眼睑全层缺损，手术操作简便，就地取材，血供可靠，能以正常的眼睑的解剖结构最大限度地恢复眼睑功能及外形，术后无明显继发畸形，是一种较理想的修复眼睑全层缺损的术式。     

岛状鼻中隔软骨粘膜瓣修复眼睑结膜和睑板缺损

目的 介绍岛状鼻中隔软骨粘膜瓣修复眼睑结膜和睑板缺损的解剖学基础和3例临床实践。方法 根据解剖研究结果,设计以鼻懵基底动脉和神经为蒂的岛状鼻中隔软骨粘膜瓣,通过眶下区皮下隧道移转到眶区,修复缺损眼睑的结膜和睑板,结果 1998年至今共治疗3例,术后软骨粘膜瓣完全成活,无并发症发生。结论 岛状鼻中隔软骨粘膜瓣血运丰富,易成活,可提供足量的组织用以修复上、下睑或上和下眼睑结膜睑板的缺损,血管神经蒂长,移转灵活,使通过常规方法不能或难以修复的眼睑缺损得以修复,供区隐蔽,无明显继发畸形。     

Forehead flap periorbital reconstruction

OBJECTIVE: To evaluate functional and aesthetic results of periorbital defect repair using forehead flaps. DESIGN: Retrospective review of patients who received periorbital defect repair by 3 of us with a paramedian forehead flap alone or in conjunction with other local or regional flaps, bone grafts, or cartilage grafts. Flap survival, functional results, and postoperative complications were determined by physical examination at regular follow-up. Three experienced surgeons other than us quantified aesthetic outcomes using a 10-cm visual analog scale. RESULTS: Eighteen patients underwent periorbital defect repair between August 1, 1989, and December 31, 2000. Defects ranged from 8 to 300 cm(2) (mean, 46.8 cm(2)) in area. The most commonly involved primary structures were the medial canthus, lacrimal drainage system, and medial upper eyelid. The mean improvement on a 10-cm visual analog scale was 1.6 from before resection to after reconstruction and 3.8 from tumor resection to after reconstruction. In all relevant cases, globe coverage and lacrimal drainage system patency were excellent. No patients experienced fistula formation or eyelid retraction. CONCLUSION: The reliability, versatility, and relative technical simplicity of the forehead flap provide excellent cosmetic and functional results in reconstruction of intermediate-sized periorbital defects, especially those associated with nasal defects.     

重睑联合内眦赘皮矫正及外眦开大术的疗效观察

目的重睑术的同时行内眦赘皮矫正及外眦开大术,观察睑裂开大的效果。方法内眦赘皮采用改良横切纵缝法矫正,外眦开大采用上睑皮瓣与下睑结膜瓣交叉的方法。重睑手术采用切开的方法,重睑切口与内外眦切口均不连续。结果本组20例患者,内眦赘皮消失,内眦较术前开大5~8 mm,外眦开大2~3 mm,睑裂明显开大。术后随访1~2年,内、外眦处瘢痕不明显,睑裂开大效果稳定,患者满意。结论重睑联合内眦赘皮矫正及外眦开大术,能显著增加睑裂的长度及宽度,而且内、外眦处瘢痕不明显,美容效果良好。     

Expanded forehead (Fricke) flap for large defect of lateral canthal area

Summary The use of an expanded forehead (Fricke) flap to repair large full thickness defects of the lateral canthus and/or of the upper eyelid is presented. The reconstruction is performed in two stages. In the first stage, a rectangular, 25 ml tissue expander (6 cm in width and 2 cm in length) is inserted under the skin lateral to and above the eyebrow; expansion is completed in about three weeks. At the second stage, the lesion is excised, and the laterally based expanded flap is elevated. Using the expanded Fricke flap, thinner, abundant skin is obtained, and the donor site is directly closed, without grafting and without distorting the eyebrow. If there is a shortage of conjunctiva, this can be reconstructed with the capsule of the expanded flap. The result is functionally and aesthetically satisfactory. This technique has been used on six patients following tumour resection in the lateral canthal area. This method is proposed as an alternative to other flaps, which can be used to reconstruct the lateral canthus, and which often gives unsatisfactory final results.Presented as poster to the 2nd International Symposium on Reconstructive Surgery of the Orbit and its Adnexa, June 9–12, Rotterdam     

眉间斧形皮瓣修复内眦及其邻近皮肤缺损

目的探讨眉间斧形皮瓣修复内眦部及其邻近的鼻根部皮肤肿瘤切除后皮肤缺损的效果。方法2017年11月至2019年10月,浙江绍兴第二医院整形美容科共收治5例内眦部及其邻近的鼻根部皮肤肿瘤患者,男2例、女3例,年龄48~61岁。皮肤肿瘤切除后,创面大小为0.9 cm×0.8 cm~2.0 cm×1.8 cm。根据缺损修复的需要,于眉间区域设计并切取斧形皮瓣,根据血供情况,皮瓣蒂部宽度与斧刃长的比例为1∶3~1∶2,将内眦动脉于内眦角处的穿支血管包含在蒂部时,蒂宽可进一步缩窄。旋转推进斧形皮瓣修复内眦部及其邻近的鼻根部皮肤缺损。观察术后效果。结果本组5例眉间斧形皮瓣均顺利成活,修复内眦部皮肤缺损3例,蒂宽为皮瓣长的1/2;修复内眦旁鼻根部皮肤缺损2例,蒂宽为皮瓣长的1/3。皮瓣面积为1.8 cm×1.0 cm~4.0 cm×2.0 cm。术后皮瓣成活良好,切口均一期愈合,术后短期内两眉间距均有一定缩窄。随访2~24个月,皮瓣色泽、质地较好,切口瘢痕纤细、平坦,对于修复内眦部病例,皮瓣的上睑部分略厚,其余病例皮瓣厚薄适中。两眉间距经过一段时间后随着皮肤逐步松弛而获得较大改善,所有患者皮肤肿瘤均无复发。医患双方对手术效果均很满意。结论眉间斧形皮瓣的质地、色泽和厚度与内眦部及其邻近的鼻根部较为接近,血供可靠,简单易行,是修复内眦部及其邻近的鼻根部皮肤肿瘤切除后皮肤缺损的较好方法。     

颞区皮下蒂皮瓣修复下睑外翻的临床效果观察

目的 探讨应用颞区皮下蒂皮瓣修复各种原因所致下睑外翻的手术方法 及临床效果.方法 自2007年以来,对于各种原因所致皮肤全层组织缺损的下睑外翻,以同侧颞部无毛发区为供区,应用外眦动脉分支血管网皮下蒂颞区横行皮瓣修复24例.病因包括:感染瘢痕8例,外伤6例,肿物切除10例,皮瓣面积最大5.5 cm×1.5 cm,最小4....     

Bipedicle Orbicularis Oculi Flap in the Reconstruction of the Lower Eyelid Ectropion

Background Lower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid. Methods This study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion. In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect. Results No problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period. The incision scars were almost invisible. Conclusions The application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion is effective and reduces postoperative morbidity.     

LONG-TERM RESULTS WITH THE PROXIMALLY-BASED NEUROVASCULAR LATERAL CALCANEAL FLAP

From 1995 to 1997, the proximally-based neurovascular lateral calcaneal flap was used in eight patients to cover defects in the Achilles tendon area or the lateral malleolar region. The mean postoperative follow-up was 40 months (range 29-51). The outcome of the operation was investigated both clinically and using a questionnaire sent to patients. All flaps healed uneventfully within a mean of 33 days. Revisional operations were required in two cases because of pain at the donor site. No flaps had broken down up to the follow-up, which was between three and five years. Two of the patients operated on were paraplegic, and the other six patients had sensate flaps. Five of the six patients with sensate flaps were able to wear normal shoes and one patient needed a shoe elevated by about 7.5 &#114 cm because of a disease independent of the flap. All but two patients were satisfied with the functional and aesthetic results. The proximally-based neurovascular lateral calcaneal flap proved to be safe and can be recommended as a good option to cover tissue defects in the Achilles tendon area or the lateral malleolar region.     

Long-term results with the proximally-based neurovascular lateral calcaneal flap.

From 1995 to 1997, the proximally-based neurovascular lateral calcaneal flap was used in eight patients to cover defects in the Achilles tendon area or the lateral malleolar region. The mean postoperative follow-up was 40 months (range 29-51). The outcome of the operation was investigated both clinically and using a questionnaire sent to patients. All flaps healed uneventfully within a mean of 33 days. Revisional operations were required in two cases because of pain at the donor site. No flaps had broken down up to the follow-up, which was between three and five years. Two of the patients operated on were paraplegic, and the other six patients had sensate flaps. Five of the six patients with sensate flaps were able to wear normal shoes and one patient needed a shoe elevated by about 7.5 cm because of a disease independent of the flap. All but two patients were satisfied with the functional and aesthetic results. The proximally-based neurovascular lateral calcaneal flap proved to be safe and can be recommended as a good option to cover tissue defects in the Achilles tendon area or the lateral malleolar region.     

Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn

While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging. This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle.     

A large lower eyelid reconstruction: nasojugal flaps plus V-Y advancement flap

Lower eyelid reconstruction still represents one of the finest expressions in oculoplastic surgery. A 76-year-old male presented with a basal cell carcinoma (BCC) of the lateral canthus, involving the inferior eyelid. After ablative surgery, the resulting full-thickness defect was reconstructed with a mucosal graft from the buccal sulcus and a nasolabial flap subcutaneously pedicled on a V-Y advancement flap. The above techniques, joined together, allow better nasojugal transposition and should be considered when lateral half of the lower eyelid and lateral canthus reconstruction are performed.     

研究应用扩张皮 修复睡周软组织缺损时综合护理干预预防脸外翻的方法及效果

的 分析综合护理干预在扩张皮瓣修复眶周软组织缺损中对睑外翻的预防效果。方法 选取遵 义市播州区人民医院2022年2月-2023年2月收治的60例眶周软组织缺损患者作为研究对象，均予以扩张皮 瓣修复治疗，按照睑外翻预防干预方式不同分为对照组和观察组，各30例。对照组应用常规护理措施，观 察组应用围术期综合预防干预，比较两组护理效果、护理满意度和并发症发生情况。结果 两组护理总有 效率比较，差异无统计学意义（P＞0.05）；观察组对美观程度、服务态度、服务方式的满意度评分均高于 对照组，差异有统计学意义（P＜0.05）；观察组并发症发生率为0，低于对照组的16.67%，差异有统计学 意义（P＜0.05）。结论 综合护理干预在行扩张皮瓣修复治疗的眶周软组织缺损患者中具有良好的临床效 果，可减少睑外翻等并发症的发生，提高患者对治疗和护理的满意度。     

针对小睑裂综合征患者的外眦开大新方法

目的：探讨小睑裂综合征患者的外眦开大新方法。方法：对8例小睑裂综合征患者采用上睑结膜瓣旋转推进法外眦开大术。结果：对8例患者进行了3个月到1年的随访,术后外眦开大效果满意。结论：本方法效果满意,可以有效避免小睑裂综合征患者外眦开大术后易重新粘连的弊端。     

Case report: the use of a modified Tenzel-type flap to reconstruct two separate peri-ocular defects

Basal cell carcinomas in the peri-ocular area account for about 20% of head and neck carcinomas [1], and synchronous non-melanoma skin cancers are a frequent occurrence, in one study occurring in 39% of patients [2]. A well-recognised and excellent way of bringing thin, texture and colour-matched skin to cover lower lid defects which cannot be closed are cheek rotation flaps [3, 4]. However, normally, the presence of a second lesion on the ipsilateral lateral canthus would prevent such flaps from being possible. Here we describe a novel modification of the Tenzel-type flap to simultaneously reconstruct two defects arising from the excision of basal cell carcinomas—one on the inferior eyelid and one on the lateral canthus. Both carcinomas were completely excised, and the patient had a good cosmetic result. The underlying concept is the integration of what may initially appear to be two mutually exclusive local flaps.