Island orbicularis oculis myocutaneous flap from the upper eyelid for lower eyelid reconstruction

An island myocutaneous flap of orbicularis oculis for reconstruction of central lower eyelid defects is presented. This flap is able to cover anterior lamellar defects extending up to 2/3 of the lower eyelid. It is also suitable for full thickness defects when the posterior lamellar involvement is less than 1/3 and can be closed primarily. In our hands this flap proved to be a good alternative to the classic reconstructive methods for the lower eyelid, since in one operation it offers the same skin quality, exactly fitting the defect, with a low complication rate. This reconstructive method for lower eyelid defects is safe, relatively simple and provides good functional and aesthetic results. Received: 21 August 1996 / Accepted: 15 June 1997     

重睑术后粘连畸形及其治疗

目的 提出重睑术后粘连畸形的概念及其治疗原则，总结各种治疗方法的临床效果。方法 将本组30例重睑术后粘连畸形者的临床表现进行了分度，根据其形成特点，采用抽除缝线、眶隔脂肪瓣移位、眶隔部眼轮匝肌下移、睑板前齿轮匝肌瓣移转、自体脂肪组织游离移植和缩短上睑提肌肌健的方法治疗。结果 术后进行3个月至2年的随访，除隔部眼轮匝肌下移、睑板前眼轮匝肌瓣多转治疗效果欠佳外，其它方法均获得满意效果。结论 治疗重睑要后连畸形应在彻底松解局部粘连的基础上，根据局部条件采用隔断粘连区的方法，可以获得满意的长期效果，     

眼睑畸形或缺损的修复与再造

文章报告了２４４例眼睑缺损或畸形病例的手术治疗方法及效果评价。烧伤后眼睑皮肤缺损的修复应尽早进行，以预防睑外翻及其它畸形的发生。下眼睑全层缺损可应用颊部旋转推进皮瓣或Ｔｅｎｚｅｌ皮瓣。睑板缺损以鼻隔软骨植入再造为好。自正常眼睑切取眼睑复合组织，带蒂或游离移植修复眼睑缺损宜慎重。眦角成形一般应留待上、下睑畸形矫正或缺损修复之后进行     

提上睑肌-额筋膜瓣吻合治疗重度上睑下垂

目的：为重度上睑下垂的治疗提供一个效果理想、外观满意的方法。方法：自2000年1月至2002年12月采用提上睑肌-额筋膜瓣吻合术治疗重度上睑下垂16例(20眼)，并对术后效果进行了随访观察。结果：本组病例术后效果良好，创伤小，医患双方均感满意。术后对其中的12例进行了半年至一年的随访，远期效果满意。结论：提上睑肌-额筋膜瓣吻合术适用于重度上睑下垂．上睑提肌肌力≤4mm的患者。     

额部扩张皮瓣在修复瘢痕性眼睑外翻中的应用

目的：探讨额部扩张皮瓣修复瘢痕性眼睑外翻的方法.方法：2006年8月～2012年4月间,笔者单位收治的13例瘢痕性眼睑外翻患者,采用额部扩张皮瓣修复,男8例,女5例,年龄17～58岁,平均36岁,病程6月～21年,其中上睑5例,下睑8例;眼睑外翻Ⅱ 度6例,Ⅲ 度7例.瘢痕挛缩致眼睑软组织缺损范围10mm × 30mm～ 45mm×50mm.手术Ⅰ期在额部埋置50～ 150ml皮肤软组织扩张器,Ⅱ 期转移扩张皮瓣至睑外翻患处,Ⅲ 期,3周后断蒂.结果：13例患者额部扩张皮瓣均成活,眼睑形态良好,睑外翻矫正,眼睑闭合自如.随访6个月～1年无睑外翻复发.结论：额部扩张皮瓣能够有效修复瘢痕性眼睑外翻.     

Treatment of congenital and acquired upper eyelid ptosis: report of 131 consecutive cases

In this paper, a 5-year experience in the management and surgical treatment of upper eyelid ptosis at the Plastic Surgery Institute of Milan University Medical School is presented. From September 1992 to April 1996 a total of 131 consecutive cases were treated surgically. The patients are grouped into three categories: those with good residual function of the levator muscle in which a levator resection procedure was performed; those with poor residual function in which a frontalis suspension was selected; and those with moderate residual function in which levator surgery was the initial treatment, followed by a second operation (frontalis suspension) in unsatisfactory results. At postoperative follow-up, 101 cases were rated good, 22 were fair, and nine were poor. Early and late complications are discussed, together with some important key-points in the management and surgical treatment of the patients. Received: 31 December 1999 / Accepted: 6 May 2000     

Total reconstruction of the upper lip after resection of a malignant melanoma

The upper lip was totally reconstructed with a radial forearm sensory flap and vermilionplasty using medical tattooing after resection of a malignant melanoma. Three courses of chemotherapy (dacarbazine, nimustine, and vincristine) were given postoperatively. The reconstructed lip had good contour, colour, and sensory recovery.     

Lower eyelid reconstruction preserving symmetry of bilateral palpebral fissure

Summary A method for lower eyelid reconstruction is reported. The lower lid defect is reconstructed with a composite flap including skin and orbicularis oculi muscle from the ipsilateral upper eyelid. To cover the donor eyelid defect, a composite graft (skin and the orbicularis oculi muscle) is taken from the contralateral upper lid. The width of the graft is half of that of the flap so that the resulting contour of the bilateral palpebral fissures is symmetrical. The donor scar is invisible being placed in the natural lid fold. The color and texture match of the reconstructed lower lid is excellent. This is a simple technique which can be done as an outpatient.     

上睑眼轮匝肌肌皮瓣在修复瘢痕性下睑外翻中的应用

目的：探讨应用上睑眼轮匝肌肌皮瓣修复轻中度下睑外翻的方法。方法：在完成上睑皮肤松弛矫正的同时，将上睑睑板表面剥离并形成上睑眼轮匝肌肌皮瓣，转移至下睑外翻患处，2周后断蒂，上睑形成重睑。结果：17例患者实施该手术后上睑形态流畅，下睑外翻基本矫正，外观满意，随访3～6个月，无下睑外翻复发。结论：应用上睑眼轮匝肌肌皮瓣修复轻重度下睑外翻是一种较为可行的手术方法。     

Schwannoma of upper eyelid: A rare differential diagnosis of eyelid swellings

Schwannoma is a relatively rare benign tumour of peripheral nerve origin. The occurrence of Schwannoma in eyelid is extremely rare. As per our knowledge, only 11 such cases have been reported in the literature so far. We present a case of a 40-year-old man who presented to us with a 2-year history of slowly enlarging, painless mass in his left upper lid with resultant progressive ptosis. Ocular examination was suggestive of a firm, non-tender nodule of size 2 × 1.5 × 1 cm on the left upper lid. The mass was non-adherent to the skin or the underlying tissue. The eyelid skin and conjunctiva were indurated and signs of inflammation were present. The lateral part of eyelid showed presence of an ulcer and the lid function was severely hampered. Provisional clinical diagnosis was that of an eyelid malignancy. With this in mind, the medial part of the lid was excised and reconstructed using a tarso-conjunctival flap from the lower eyelid in conjunction with a skin graft. The histopathology and immunohistochemistry established the diagnosis of Schwannoma. We recommend that Schwannoma be considered in the differential diagnosis of well-circumscribed eyelid swellings.     

上睑皮肤松垂的整复治疗

为提高上睑皮肤松垂患者的手术疗效，１０年来，作者改进了手术设计方法，采用术前让受术者取坐位，用蘸有美蓝的有齿镊，夹持上睑多余的皮肤，同时作出相应的标记，描出须切除的上睑皮肤量。此外，在术中检查切口两侧皮肤，在自然松弛状态下是否刚好对合，以此为标准，进一步调整须切除的多余皮肤量。术后既整复了倒睫，恢复视野和视力，也获得满意的美容效果，而且手术并发症发生率大大降低，有助于提高手术成功率。它是治疗上睑皮肤松垂患者较理想的方法。     

Fricke supraorbital flap for reconstruction of total lower eyelid defects

Summary Split or full thickness eyelid defects resulting from tumor destruction or surgical excision present a dilemma for plastic and reconstructive surgeons. Full thickness eyelid replacement requires composite grafting of the skin, together with tarsal support of its substitute and mucosa. The flap described by Fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid defects. In three of our cases chondromucosal grafts taken from nasal septum were utilized for posterior lamella repair. The results have been satisfactory from a functional and cosmetic standpoint.     

皮瓣结合重睑术修复上睑皮肤缺损的临床应用

目的：探讨较大的上睑皮肤肿物切除后的修复方法。方法：针对不同年龄的患者,采用推进皮瓣或旋转皮瓣结合不同的重睑术式一次性修复较大的上睑皮肤肿物切除后的皮肤缺损。结果：上睑皮肤肿物切除后的皮肤缺损完全修复,无睑外翻、眉下垂发生,双上睑形成对称的重睑线。结论：根据患者上睑皮肤肿物的部位、大小以及上睑皮肤的松弛程度采用不同的皮瓣并结合不同的重睑术式可有效的修复肿物切除后形成的皮肤缺损,既避免术后睑外翻、眉下垂的发生,又最大程度的维持了双上睑形态的对称性,且增加眼部的美感。     

扩张的额部复合皮瓣预制法鼻再造术

目的：探讨一种应用扩张的额部复合皮瓣预制进行鼻再造的手术方法。方法：2008年7月～2010年1月,对7例鼻缺损患者分四期行鼻再造术。一期：埋植额部扩张器,同时额部皮下移植自体软骨,额肌深面中厚植皮;二期：取扩张器,行额部扩张复合皮瓣转移鼻再造术;三期断蒂;四期修整。结果：7例患者手术后随访6～12个月,手术均取得较好的效果。结论：扩张的额部复合皮瓣预制法鼻再造术为修复鼻全层缺损提供了一种新的术式选择。     

Eyelid reconstruction using cartilage grafts from auricular scapha

The main goal, in eyelid reconstruction, is to promote an adequate protection to the ocular globe, through the reconstitution of all anatomic plans. In order to obtain adequate stability, cartilage grafts are often used in the repair of the internal lamella. Cartilage grafts from auricular scapha in contact with the bulbar conjunctiva were used in this study. Nineteen patients with various pathologies had 20 eyelid reconstructions using this technique (10 cutaneous tumors, 7 post-traumatic, and 3 cases of lower eyelid retraction). Local cutaneous flaps (glabella, Mustardè, etc) were used to reconstruct the external lamella. Epithelialization on the perichondrium (confirmed by the histological examination) occurs between 3 to 4 weeks. The functional and aesthetic result was considered good in 14 cases (70%), acceptable in 5 (25%) and poor in one case (5%). The donor area showed no complications or deformities. The shape of the scapha allows satisfactory conformation of the graft to the curvature of the ocular globe; it is not flat like the nasal septum, and has a smoother curvature than the auricular concha. Furthermore, it is thinner and that is another reason why the aesthetic result was superior to the technique previously used. The functional results were similar. Received: 20 June 1998 / Accepted: 21 September 1998     

Full upper lip reconstruction following cancer excision

Full upper lip reconstruction is a challenging area, the problems are those related to the restoration of all anatomical structures of this esthetic unit, such as the Cupid's bow, the philtral columns and groove, the vermillion, and in males, the hair-bearing skin. In order to solve some of these problems, a temporoparietal scalp flap has been used for full upper lip reconstruction, with an extension of the end the flap in the forehead region, in females. The flap previously described by Converse for nose reconstruction can overcome some disadvantages inherent in other reconstructive methods.     

眼轮匝肌层间分离重睑成形术治疗青少年上睑倒睫的临床疗效

目的探讨眼轮匝肌层间分离重睑成形术治疗青少年上睑倒睫的临床疗效。方法采用3点式皮肤切开．做肌间及肌下双层面隧道式分离,去除预设重睑线下至睑缘上方1mm范围的深部眼轮匝肌及肌下组织,缝合固定浅层眼轮匝肌于上睑提肌腱膜。对上睑睫毛做3等份分区,分别测量睫毛的方位,即睫毛根部提升角（lift—upangle,LA）、睫毛体部卷曲角（bodycurl—upangle,BC）、睫毛末端卷曲角（endcurlupangle,EC）,将将测量数据做定量分析。结果57例114只眼术后24个月时,I区睫毛LA由术前的（26．37±9．67）°提升到术后的（55．42±10．03）°（P〈0．01）,11区睫毛LA由术前的（22．03±11．64）°提升到术后的（50．03±10．02）°（P〈0．01）,Ⅲ区睫毛LA由术前的（25．31±8．01）°提升到术后的（64．05±8．33）°（P〈0．01）,BC及EC在手术前后无明显变化（P〉0．01）。结论针对青少年上睑倒睫的患眼,采用眼轮匝肌层间分离重睑成形术的方法治疗,可获得较为美观的重睑形态和理想的消除倒睫的睫毛位置。     

A case report of reconstruction of ocular and complete upper eyelid avulsion with severe facial soft tissue injuries using anterolateral thigh free flap

Introduction and importanceOcular injury is second mostly caused by motor vehicle accident (MVA) and often leads to severe ocular injury even to visual loss and various aesthetic problems. The outcome is determined by the magnitude of the initial damage and treatment availability. Treating ocular and facial injury due to MVA is challenging given the scope of the damage and may result in various outcomes.Case presentationThis case presented a 22-years old woman with a history of car accident assessed with total upper eyelid avulsion with corneal perforation and involvement of multiple facial fractures on the left side. The visual function is irreparable due to the extensive corneal defect from exposure and secondary infection, and possible optic nerve damage.Clinical discussionThis case presented a complete upper eyelid avulsion with severe facial tissue injury. Therefore, the reconstructive procedure main objectives are to maintain appropriate prosthetic position and to improve cosmetic function. This case used anterolateral thigh free flap as the reconstructive surgery method because it is convenient for large defects and the donor scar is not visible. After completing the surgery and several follow-up procedures, the patient recovered without any significant complications.ConclusionDespite visual loss due to the extent damage of the eye, it is important to restore the facial damages. Visual function is as crucial as cosmetic function in determining the patient’s quality of life.     

两种术式治疗甲状腺相关眼病上睑退缩的比较

目的对比两种术式矫正甲状腺相关眼病上睑退缩的临床疗效。方法将22例(32只眼)甲状腺相关眼病上睑退缩患者,随机分为A、B两组。A组11例18只眼采用上睑提肌中央腱膜切断术矫正;B组11例14只眼采用上睑提肌和Muller肌延长术矫正。术后随访6个月,评价其临床疗效。结果所有患者术后自觉症状均明显减轻或消失,A组及B组各自术前与术后疗效相比,均有统计学意义(P<0.01),组间比较无统计学意义(P>0.05)。术后6个月A组有4例6眼,B组有1例1眼上睑回退,经卡方检验,回退率组间比较有统计学意义(P<0.05)。两组均无一只眼过矫。结论两种术式均可有效矫正静止期甲状腺相关眼病的上睑退缩,但上睑提肌和Muller肌延长术回退率低。