对位睑板结膜瓣滑行修复眼睑缺损

目的：评价对位睑板结膜瓣滑行修复眼瞪缺损的效果。方法：对41例眼瞪全层缺损患者,其中上睑10例,下睑31例,切除肿瘤导致缺损者33例。外伤导致缺损者8例,缺损范围在1/3-2/3,年龄24-79岁,采用与缺损眼睑相对应的眼睑睑板结膜瓣滑行至缺损区来修补眼睑缺损。结果：术后随访31例,随访时间3月-5年,除缺损外,1例出现轻度上睑退缩（退缩量为1-2mm),1例出现轻度下睑外翻,余眼睑外形及功能均基本恢复,眼睑活动自如,闭合完全,无严重并发症发生,结论：对位睑板结膜瓣滑行可用于修复眼睑后层缺损,且不受有无睑板替代物的限制。不需另添手术创口,可更好地恢复眼睑的功能及外观。     

用易位睑板结膜瓣修复眼睑缺损

用易位睑板结膜瓣修复眼睑缺损郑州市第二人民医院眼科孙芳利用上睑或下睑缺损区以外残存的睑板睑结膜，设计成易位睑板结膜瓣１期修复全层部分睑缺损１０例１２只眼，取得了满意的效果。重建了眼睑功能。达到术后外形的美观。材料及方法一般材料１０例１２只眼，男８例，...     

应用上睑板结膜瓣再造下睑

目的:评估采用上睑板结膜瓣作为下睑肿瘤切除后缺损再造的临床效果。方法:在膨胀液的麻醉下对34例(34眼)下睑基底细胞癌进行彻底切除造成的大范围缺损,以上睑板结膜瓣作为衬里,残存下睑皮肤或眼面部皮肤作为前层进行再造。结果:随访8mo～5a以上的31例患者中,所有患者均存活,其外观及功能良好,无1例发生角膜炎、睑内、外翻畸形等并发症,美容效果满意。结论:应用上睑板结膜瓣及残存的下睑皮肤或眼面部皮肤滑行再造下睑是可取的。     

深低温保存异体睑板睑结膜移植修复眼睑缺损的临床观察

目的 评价深低温保存异体睑板睑结膜移植修复,因眼睑肿物切除造成的眼睑缺损的临床效果.方法 采用深低温保存异体睑板睑结膜移植眼睑再造术修复眼睑缺损21例(21只眼).结果 术后随访3～80月,平均46.9月.本组病例共治愈10只眼,好转11只眼,1例(1只眼)因首次手术时切缘未净再次行扩大切除时未更换移植片导致植片脱落.结论 深低温保存异体睑板睑结膜移植修复眼睑缺损,简便易行,保存方便,术后并发症少,临床效果满意.异体睑板睑结膜是理想的眼睑缺损修复的材料.     

异体睑板移植修复眼睑缺损

目的 修复21眼因各种原因所致的部分或全层眼睑缺损。方法 采用低温保存的异体睑板移植替代瞪板,内层行结膜转移或唇粘膜移植。外层应用邻近带蒂皮瓣或游离显效5眼,改善2眼,失败1眼,术后效果与血运 的好坏和移植片的大小有关。结论 采用低温保存的异体睑板修复眼睑缺损,排斥反应轻,疗效佳。是替代睑板的理想材料。     

自体睑板移植修复1/2眼睑缺损

自 2 0 0 1年 7月以来 ,我们以自体健眼睑板移植片一期修复肿瘤切除后的 1/2眼睑缺损 ,取得满意效果。现将我院的治疗结果和具体技术介绍如下。一般资料 :11例因眼睑肿块就诊的患者 ,男性 4例 ,女性 7例 ,年龄 42～ 78岁 ,平均 61岁 ;右眼 5例 ,左眼 6例 ,上睑 7例 ,下睑 4例。其中 ,8例患者已行肿块活检 ,病理证实为“睑板腺癌” ;其余 3例临床上呈现典型的睑板腺癌征象 ,即睑结膜面白色结节样隆起。全部病例肿瘤范围不大于6mm ,均未侵入穹隆部 ,耳前、颌下淋巴结未及肿大。方法 :①自体睑板的制备 :地卡因表面麻醉 ,利多卡因穹隆部浸润麻…     

异体巩膜联合自体结膜滑行瓣修复眼睑缺损

目的探讨异体巩膜联合自体结膜滑行瓣修复眼睑全层缺损的ll缶床效果。方法对10例因肿瘤切除术或外伤后造成的眼睑全层缺损范围等于或大于1／3眼睑的患者行异体巩膜移植联合自体结膜滑行瓣修复眼睑后层缺损,并随访观察半年至2年。结果全部病例经眼睑重建术后,异体巩膜无溶解或排斥现象,植片生长良好,无巩膜暴露,眼睑形态基本正常,对眼球无刺激,对视功能无影响,肿瘤未见复发。结论对于因肿瘤切除术或外伤造成的眼睑全层缺损,异体巩膜联合自体结膜滑行瓣术式是一种有效的手术方式。     

兔异体睑板睑结膜移植修复眼睑缺损实验研究

目的比较甘油、酒精及深低温3种方法保存兔异体睑板修复眼睑缺损的有效性和术后组织病理学反应及细胞凋亡情况。方法分3组进行甘油、酒精及深低温保存兔异体睑板睑结膜移植修复眼睑缺损各16眼,术后1周、1月及3月分别取材用光镜观察植片的组织病理学改变,并以原位末端标记（TUNEL）技术观察移植后细胞凋亡情况。结果3组术后均有不同程度的炎性反应出现,深低温保存兔异体睑板移植术后临床及组织病理学观察炎性反应轻于甘油及酒精保存材料移植后反应;3组均出现细胞凋亡现象,深低温组移植术后凋亡细胞数量较甘油、酒精组少。结论深低温保存的兔异体睑板移植修复眼睑缺损活性高,简便易行,保存方便,术后并发症少,排斥反应小,是理想的眼睑缺损修复的材料。     

鼻中隔软骨粘膜片和耳后皮瓣修复上睑全层缺损

患者 ,男 ,41岁 ,住院号 0 80 841,左眼睑被他人咬伤 2小时入院。检查 :右眼上睑中部有 15ｍｍ× 10ｍｍ范围全层缺失 ,仅在靠距内、外眦角残留少量睑板边缘组织 ,上方眼轮匝肌组织及穹隆结膜暴露 ,球结膜显著充血、水肿 ,角膜上皮水肿明显 ,荧光素钠染色 (-) ,角膜后ＫＰ(-) ,房水闪光 (-) ,前房深浅适中 ,瞳孔对光反应良好 ,余窥不进。诊断 :右眼睑咬伤 ,上睑全层缺损。手术方法 :常规消毒整个颜面区域及右耳后皮肤 ,清理创面并测量缺损范围。局部麻醉后 ,入左侧鼻孔纵形切取 15ｍｍ× 10ｍｍ大小带有鼻粘膜的鼻中膈软骨瓣 ,尽量避免穿孔 …     

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction

AIM: To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. METHODS: Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as “good”, “fair”, and “poor” by evaluating the margin appearance, eyelid appearance, and complications. RESULTS: A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a “good” outcome (88.1%), 5 patients had a “fair” outcome (11.9%), and no one had a “poor” outcome. CONCLUSION: Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.     

Bietti’s crystalline dystrophy in an African American patient: an unusual racial demographic for a condition more common in individuals of East Asian descent

AIM: To investigate the suitability of a modified Hughes procedure, which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect. METHODS: Patients with full thickness eyelid carcinoma involving more than 50% margin length who underwent surgical resection were retrospectively reviewed in the study. The defects were reconstructed using conjunctival flap with auricular cartilage grafting, covered with myocutaneous flap above. Followed-up time ranged from 12 to 24mo. Outcomes were classified as “good”, “fair”, and “poor” by evaluating the margin appearance, eyelid appearance, and complications. RESULTS: A total of 42 patients were enrolled in the study (26 males, 16 females, mean age, 68.6±7.7y, range: 53 to 82y). The mean defect widths measured 23.2±2.9 mm (range, 17 to 28 mm). The mean posterior lamellar defect height was 5.5±1.3 mm (4 to 8 mm). Thirty-seven patients had a “good” outcome (88.1%), 5 patients had a “fair” outcome (11.9%), and no one had a “poor” outcome. CONCLUSION: Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect. It can not only achieve satisfied reconstruction, but also preserve intact tarsal plate of the opposite eyelid, avoiding retraction or entropion.     

Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft

Purpose: To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery.Methods: This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50–75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft.Results: All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort.Conclusion: Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.     

Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM: To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS: The clinical data of 23 patients (23 eyes) who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed. All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterior- or posterior-layer eyelid defects. The survival rate of the propeller flap, eyelid function and appearance, tumor recurrence rate, and patient satisfaction were evaluated after the surgery.RESULTS: The patients consisted of 12 men and 11 women, aged 31–82y (mean, 58.9y). The longest follow-up time was 5y, and the shortest was 3mo. All the propeller flaps survived well. There was no significant difference in color and luster between the flap and adjacent tissues, and there was no dog ear phenomenon. No obvious scarring was observed. There were no obvious abnormalities of eyelid morphology or function, and no adverse complications such as exposure keratitis, entropion, ectropion, ptosis, and eyelid retraction. No tumor recurrence was found at the time of the last follow-up. All patients were satisfied with the surgical results.CONCLUSION: The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactory outcomes in terms of eyelid function and esthetics, and merits clinical application.     

颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损

目的探讨颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损的适应证、安全性和有效性。方法根据颞浅血管的解剖分布,制备以颞浅动脉为蒂形成的顺行岛状皮瓣,通过皮下隧道移转至缺损区,修复各种原因所致的重度眼睑及眶周组织缺损患者18例（18眼）。术后随访6个月,观察皮瓣存活、眼睑功能恢复情况和手术效果。结果16例皮瓣完全存活,皮瓣颜色与受区皮肤相近,质地柔软,皮瓣感觉功能良好,睑裂闭合良好,外观满意。1例术后早期出现静脉回流障碍,经积极处理,皮瓣远端有小片表皮坏死。1例皮瓣因严重静脉淤滞坏死,术后3个月行游离植皮术,植皮存活。6例患者因皮瓣肿胀,行Ⅱ期修整术。结论颞浅动脉顺行岛状皮瓣具有血供丰富、色泽质地与受区相近等优点,是修复重度眼睑及眶周组织缺损并重建眼睑功能和外观理想的皮瓣。     

改良结膜瓣掩盖术在眼球萎缩安装义眼时的应用

目的评价改良的结膜瓣掩盖术在轻中度眼球萎缩安装义眼时应用的效果。方法轻中度眼球萎缩11例行角膜浅板层切除、异体巩膜包盖及全结膜瓣掩盖术，术后3周安装定制的个性化义眼。随访半年，观察其效果。结果双侧睑裂高度、眼睑饱满度及眼球活动度均十分相似，容貌显著改善，外观满意。结论改良的结膜瓣掩盖术联合个性化义眼安装用于轻中度眼球萎缩，可获得良好的美容效果。     

Superiorly hinged blepharoplasty flap for reconstruction of medial upper eyelid defects following excision of xanthelasma palpebrum

This paper documents an interventional case series which describes a novel technique for reconstructing large medial upper eyelid skin defects following excision of xanthelasma palpebrum. All visible upper eyelid xanthelasma is excised and a superiorly hinged blepharoplasty skin flap is created with a classic skin crease and lateral blepharoplasty incision, the latter acting as an effective 'back-cut' to allow medial advancement of the flap into the defect. Excess triangles of skin are excised and the flap is sutured without tension into the defect in a conventional manner. The patients selected were patients with medial upper eyelid skin defects not amenable to direct closure following surgical excision of xanthelasma. The main outcome measures were the upper eyelid aesthetic and functional outcome, postoperative complications and need for revisionary surgery. In our study seven patients with bilateral medial upper eyelid xanthelasma excised and reconstructed with this technique were identified. Good aesthetic outcome and high patient satisfaction without functional compromise was achieved in all patients at the last follow-up visit. Patient age ranged from 30–52 years old. Follow up ranged from 8 to 18 months. In conclusion, the superiorly hinged blepharoplasty skin flap is a novel and simple technique for the reconstruction of skin defects that are not amenable to direct closure following xanthelasma excision. It avoids the complications of skin grafting and non-surgical ablative methods, particularly in dark-skinned patients.     

转移皮瓣修复眼眶组织巨大缺损

目的:观察几种不同类型转移皮瓣修复眼眶组织巨大缺损的临床效果,探讨眼眶组织巨大缺损的修复技巧。方法:回顾性分析16例被恶性肿瘤广泛破坏眼睑、眶周皮肤、眶内球旁组织及眼球的患者。行控制性或扩大切除肿瘤后,利用眶周健康组织形成转移皮瓣进行修复缺损区,供皮处缺损区取上臂内侧或腹部全厚游离皮片修复。观察术后6mo皮瓣存活情况,分析与皮瓣存活有关的术式及皮瓣类型。结果:患者16例中接受控制性切除肿瘤的患者12例12眼,扩大切除肿瘤者4例4眼;缺损区采用额部或额顶部轴型皮瓣修复10例10眼,皮下蒂皮瓣4例4眼,反转皮瓣2例2眼;术后接受放射治疗12例12眼,未接受放射治疗4例4眼,随访至术后6mo,所有皮瓣均存活。结论:转移皮瓣是修复眼眶组织巨大缺损的安全、有效方法。     

异体巩膜移植治疗眼睑恶性肿瘤术后睑板缺损的临床观察

目的：探讨异体巩膜移植在眼睑恶性肿瘤切除术后睑板缺损重建手术中的临床效果。

方法：对24例24眼眼睑恶性肿瘤术后睑板缺损长度大于1/2睑板的患者实施眼睑重建, 利用异体巩膜替代睑板,异体巩膜材料取自眼库。

结果：术后3～12mo随访,眼睑重建术后形态良好,未出现明显的异体巩膜溶解或排斥反应; 巩膜脉络膜面均被结膜细胞移行覆盖,异体巩膜与皮肤粘连紧密,缺损区修复完整。4眼出现睑缘轻、中度内翻后行眼睑内翻矫正。2眼出现不同程度睑球粘连,行睑球粘连分离手术。

结论：异体巩膜具有材质稳定性好、组织相容性佳、取材保存方便、手术操作简单易行等优点。术后眼睑功能良好、外观满意,是理想的睑板替代材料。