A New Technique for Levator Lengthening to Treat Upper Eyelid Retraction: The Orbital Septal Flap

Correction of upper eyelid retraction can be achieved by numerous techniques. We have developed a new flap, the orbital septal flap, to interpose between the recessed levator complex and the tarsus to correct the retracted upper eyelid of a young girl. The orbital septum is a facial structure; it is readily available and easy to dissect. The flap acts like a vascularited spacer without the problem of resorption; normal anatomical continuity of the levator mechanism can be functionally restored. We believe the orbital septal flap is a promising technique for correcting upper eyelid retraction; however, more case studies are needed.     

应用局部皮瓣修复上睑全层缺损一例报告

目的探讨局部皮瓣修复上睑全层缺损的价值。方法2007年3月,对一例狗咬伤所致的右侧上睑全层缺损进行急诊局部皮瓣修复手术。结果术后随访45d,右侧上睑外形满意,功能良好。结论应用局部皮瓣急诊修复眼睑全层缺损,术后效果满意,可避免Ⅱ期手术和睑缘缝合。     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

眼轮匝肌岛状皮瓣在面瘫性下睑外翻修复中的应用

目的：探索应用下睑眼轮匝肌瓣结合颞部眼轮匝肌肌皮瓣治疗面瘫性下睑外翻的一种新方法。方法：用下睑眼轮匝肌瓣复合颞侧眼轮匝肌肌皮瓣加强下睑修复面瘫性睑外翻，同时利用现有切口提升患侧面部。结果：7例患者术后皮瓣全部成活，随访4月至1年，下睑外翻的症状都得到了矫正，面部松弛的症状也有不同程度的改善，供瓣区瘢痕不明显。结论：应用颞部眼轮匝肌肌皮瓣加强下睑，眼轮匝肌瓣供血好成活率高，同时应用下睑眼轮匝肌瓣外侧悬吊能有效地纠正下睑外翻，改善患侧面部不对称。     

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.     

眶上动脉跨区供血的反流轴型耳前岛状皮瓣修复眼睑皮肤组织缺损

目的探讨眶上动脉跨区供血的耳前岛状皮瓣修复眼睑皮肤缺损,并验证其是否为最佳的皮瓣供区.方法根据陈宗基关于动脉经吻合支跨区反流灌注供血的反流轴型皮瓣的理论与实践,设计以眶上动脉为蒂,经眶上动脉与颞浅动脉额支的吻合支跨区反流供血的耳前岛状皮瓣,经皮下隧道移转修复眼睑皮肤组织的缺损,1997～1999年共治疗7例,面积最大4.0cm×2.4cm,最小2.0cm×1.8cm.结果7例均全部成活,随访l～2年,效果良好.结论眶上动脉跨区供血的反流轴型耳前岛状皮瓣具有稳定、可靠的血供保障,耳前皮肤组织的质地、色泽都与眼睑极为相似,是修复眼睑组织缺损的理想皮瓣供区.     

联合筋膜鞘+提上睑肌复合瓣悬吊矫治先天性重度上睑下垂

目的:探讨联合筋膜鞘+提上睑肌复合瓣悬吊治疗先天性重度上睑下垂的临床效果。方法:选取2017年9月至2019年3月于河北省眼科医院住院的先天性重度上睑下垂患者205例248眼,随机分为三组,分别应用联合筋膜鞘+提上睑肌复合瓣悬吊术(CFS+L复合瓣悬吊组)、联合筋膜鞘悬吊术(单纯CFS悬吊组)、额肌瓣悬吊术(额肌瓣悬吊组)加以矫正;随访6个月,比较三组患者正矫率、上睑回退率、上睑活动范围及眼睑闭合不全情况、并发症发生率和患者满意度。结果:CFS+L复合瓣悬吊组较其他两组有更高的正矫率,CFS+L复合瓣悬吊组及单纯CFS悬吊组术后较额肌瓣悬吊组有更好的上睑活动度、眼睑闭合不全状态较轻、并发症发生率较低,患者满意度较高;CFS+L复合瓣悬吊组较单纯CFS悬吊组术后上睑回退率低、具有更好的稳定性;差异均有统计学意义(P<0.05)。结论:联合筋膜鞘+提上睑肌复合瓣悬吊术矫正先天性重度上睑下垂具有治愈率高、效果更加稳定的特点,是一种符合眼睑活动生理学特点的动态术式。     

应用扩张预制黏膜衬里皮瓣修复眼睑缺损

目的 探讨眼睑全层缺损修复的新方法。方法 在额部扩张皮瓣的内面移植口腔黏膜，待黏膜成活后与皮瓣一起转移至眼睑部，分层缝合。4个月后行上、下睑裂分开，安装义眼。结果 修复后的外形较好，恢复了部分功能。结论 在扩张后的皮瓣内预制黏膜衬里皮瓣是修复眼睑全层缺损的一种较好的可行方法。     

应用眼轮匝肌蒂颞部岛状皮瓣矫正睑外翻

目的探讨应用眼轮匝肌蒂颞部岛状皮瓣修复睑外翻的方法及效果。方法设计以眼轮匝肌为蒂的颞区皮瓣,将皮瓣旋转180°移位至眼睑部瘢痕松解后的创面,修复瘢痕性睑外翻。结果术后12例患者,皮瓣完全成活,随访6个月,睑外翻无复发,供区瘢痕不明显。结论眼轮匝肌蒂颞部岛状皮瓣血供可靠,修复睑外翻可取得功能与外观双重修复的满意结果。     

以硬腭粘骨膜瓣做衬里的颞部扩张皮瓣修复下睑全层缺损

目的:总结应用以硬腭粘骨膜瓣做衬里的颞部扩张皮瓣修复全层下睑缺损的临床经验。方法:Ⅰ期手术选用50-70ml容量的扩张器埋置于颞部皮下,注水扩张2~3个月,Ⅱ期切取硬腭粘骨膜植于扩张皮瓣内侧,形成复合皮瓣,Ⅲ期取出扩张器,将预置成活的复合皮瓣修复眼睑缺损,恢复睑缘正常形态。结果:2008-2012年收治6例下睑缺损患者复合皮瓣全部成活,眼睑外观和功能满意。结论:以硬腭粘骨膜瓣做衬里的颞部扩张皮瓣修复全层下睑缺损效果肯定,具有较高的临床价值。     

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。     

重睑成形术后重睑过宽粘连畸形的修复

目的 探索重睑成形术后重睑过宽粘连畸形的修复方法.方法 重新设计重睑线宽度为6～8 mm,去除上睑瘢痕性皮肤1～2 mm,彻底松解局部粘连,利用眶隔脂肪瓣,邻近眼轮匝肌肌瓣、眼轮匝肌下脂肪垫及脂肪颗粒注射,充填上睑凹陷粘连区,重新缝合.结果 共修复16例患者20侧上睑,其中利用上睑眶隔脂肪瓣修复2例2侧,眼轮匝肌肌瓣修复3例4侧.眼轮匝肌下脂肪垫修复8例10侧,脂肪颗粒注射充填3例4侧.术后随访12例,10例14侧医患双方满意,2例2侧患者可以接受.结论 利用眶隔脂肪瓣、眼轮匝肌肌瓣、眼轮匝肌下脂肪垫、脂肪颗粒注射充填修复重睑过宽粘连畸形有效可行.     

睑袋整复术后下睑外翻的综合矫治

目的:探讨下睑整复术后其下睑外翻的综合矫正方法。方法:本组病例采用皮瓣和肌瓣的游离,眶隔松解,切除下睑三角形组织瓣,眼轮匝肌悬吊等综合治疗方法予以矫正。结果:本组下睑皮肤松弛和睑袋整复术后并发严重下睑外翻患者15例16侧,采用综合下睑外翻矫正术后均取得满意效果。结论:应用综合方法矫正下睑外翻是一种可行的下睑外翻的矫正方法。     

Lower eyelid aesthetics after endoscopic forehead midface-lift

OBJECTIVE: To assess and quantitate the immediate effect of endoscopic forehead midface-lift on infraorbital hollowing and lower eyelid skin excision. METHODS: Twenty-five patients who underwent an endoscopic forehead midface-lift with a lower eyelid blepharoplasty or lower eyelid blepharoplasty without a midface-lift between January 1, 2005, and May 15, 2005, were included in the study. Preoperative and immediate postoperative measurements of the vertical height of the lower eyelid were taken in all patients. The change in the vertical height of the lower eyelid after endoscopic forehead midface-lift with blepharoplasty was compared with the change in lower eyelid height after either transconjunctival or lower eyelid skin pinch blepharoplasty or skin muscle flap blepharoplasty alone. The amount of lower eyelid skin excised after endoscopic forehead midface-lift with blepharoplasty was compared with both transconjunctival or lower eyelid skin pinch blepharoplasty and skin muscle flap blepharoplasty when a midface-lift was not performed. RESULTS: The average change in the vertical height of the lower eyelid after the endoscopic forehead midface-lift was 5 mm. Lower eyelid blepharoplasty alone, whether transconjunctival with skin pinch or skin muscle flap, did not affect the vertical height of the lower eyelid. The change in the vertical height of the lower eyelid with midface surgery over blepharoplasty alone was statistically significant (P < .001). The average amount of lower eyelid skin excised after endoscopic forehead midface-lift and lower eyelid skin pinch was 7.0 mm compared with 5.5 mm for both the transconjunctival lower eyelid skin pinch and the skin muscle flap techniques. The difference in skin excision when a midface-lift was performed compared with blepharoplasty alone was statistically significant (P = .008). CONCLUSIONS: The endoscopic forehead midface-lift can reduce the vertical height of the lower eyelid by an average of 5 mm and allows more skin excision over blepharoplasty alone. The endoscopic forehead midface-lift is a powerful tool for decreasing the vertical height of the lower eyelid, lessening infraorbital hollowing, and improving dermatochalasis.     

Orbicularis oculi myocutaneous flap in reconstruction of postburn lower eyelid ectropion.

The management of postburn lower eyelid ectropion is difficult, since the contraction of the skin graft may give rise to secondary deformities especially around the lateral 1/3 of the lower eyelid. In this paper, the results of reconstruction in lower eyelid ectropion with a laterally based orbicularis oculi myocutaneous flap from the upper eyelid in 7 young patients are presented. Satisfactory function and cosmesis were obtained in the evaluation of the patients up to 40 months follow-up. The method proved versatile as the donor scar was well-hidden in the supratarsal fold and the temporally based myocutaneous flap provided additional support to the lower eyelid by exerting an upward pull against the gravity. It is concluded that usage of this flap in postburn ectropion cases is worthwhile to avoid any recurrences. reserved.     

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.     

Ear helix flap for reconstruction of total loss of the upper eyelid.

We present a patient with a recurrent carcinoma of the right upper eyelid who underwent resection of the subtotal upper eyelid resulting in a full-thickness defect. The eyelid was reconstructed with advanced conjunctival lining and an ascending helix chondrocutaneous flap from the right auricle. This flap was nourished with a reverse flow of the frontal branch of the superficial temporal vessels. A superficial temporal vein of the flap was anastomosed to the zygomaticofacial branch of the superficial temporal vein at the lateral canthal region to ensure adequate drainage. The flap survived without any congestion. An ascending helix flap is the best candidate for total loss of the upper eyelid.     

眶隔筋膜瓣及提上睑肌与额肌瓣吻合悬吊矫正重度上睑下垂

目的：研究利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣悬吊矫正重度上睑下垂的临床效果。方法：术中切开眶隔,形成蒂在睑板上缘的眶隔筋膜瓣,在眉部分离形成额肌瓣,将这两瓣与提上睑肌腱膜重叠缝合固定,建立与额肌的连接,悬吊上睑并矫正下垂畸形。结果：采用此方法对27例35侧重度上睑下垂的眼睑进行了治疗,随访3～6个月,其中31侧眼睑取得了满意的效果,额肌收缩时患睑睁大两侧眼裂大小对称,睑缘位置正常,外形自然,睑缘弧度及重睑外形满意。矫正不足4侧,后行二次手术而修复。结论：利用眶隔筋膜瓣、提上睑肌腱膜联合额肌瓣重叠吻合悬吊矫正重度上睑下垂,上睑悬吊牢固,不易复发,保持了眼睑的原有结构,睑缘和重睑线弧度及外观满意,畸形矫正效果良好,优于传统的上睑提肌腱膜瓣悬吊和单纯额肌悬吊的方法。