瘢痕性睑外翻的手术矫正

目的探讨瘢痕性睑外翻手术矫正的临床疗效。方法采用眼睑瘢痕切除、睑缘延长量楔形切除及游离植皮的方法,对23例（43眼）因瘢痕性睑外翻进行手术矫治,并观察其临床效果。结果本组伤后1～2个月手术5例（9眼）,〉6个月手术17例（32眼）,术后植皮成活良好,3例（3眼）于手术后1个月发生轻度睑裂闭合不全,无睑缘外翻,未处理;2例（2眼）于2个月后因面部瘢痕挛缩致使睑外翻,需再次手术处理;余经6个月～4年随访,效果良好。结论根据眼睑皮肤缺损大小,睑缘延长量多少设计手术方法,取耳后、锁骨上窝或上臂内侧全厚皮片、游离皮片修复睑皮肤缺损,效果良好。     

眼睑恶性肿瘤切除中度眼睑缺损的即期整复

目的 探讨眼睑恶性肿瘤切除后所致大面积眼睑缺损的手术整复方法和技巧.方法 在局部麻醉或全身麻醉下,手术切除上下睑病变组织,后层缺损采取结膜睑板瓣修补或硬腭、异体巩膜移植替代睑板;前层采用全厚皮片游离移植或带蒂皮瓣滑行转位修补睑皮肤缺损,进行眼睑缺损的一期修复.结果 临床治疗患者9例,术后均获得一期愈合;效果满意.结论 恶性眼睑肿瘤所致的大面积眼睑缺损,在切除肿瘤的同时立即行眼睑缺损的一期整复,效果确实、疗效满意.     

眼睑游离皮片移植术

在眼部成形手术中,游离皮片移植术占有很重要的位置。眼睑及其周围皮肤凡因创伤、炎症、化学腐蚀、烧烫伤引起皮肤瘢痕收缩、牵引睑缘离开眼球,造成眼睑外翻或睑裂闭锁不全,或因肿瘤切除造成眼睑皮肤或眼睑全层缺损的,均须做睑成形手术。     

眼睑皮肤缺损利用阴茎皮肤修复的效果

目的 评价男性眼睑皮肤缺损,采用阴茎皮肤游离皮片移植术修复整形,恢复眼睑功能和容貌的效果.方法 自2003年1月至2011年8月,男性眼睑皮肤缺损32例,切取自体阴茎皮肤,制成相应植床大小的游离皮片,如不足植床面积再辅以睑周围皮瓣修复整形.结果 32例术后观察6 ～ 24个月,眼睑功能和容貌基本恢复.结论 采用阴茎皮肤游离皮片移植术,可有效治疗眼睑皮肤缺损,效果良好.     

异体巩膜移植修复眼睑缺损临床观察

目的 观察同种异体巩膜及自体皮瓣移植修复眼睑恶性肿瘤组织学控制性切除及严重眼外伤造成眼睑缺损的远期效果。方法 22例(22只眼)眼睑缺损患者，全部用异体巩膜及自体皮瓣移植行眼睑修复。结果 术后随访5个月～16年。13例恶性肿瘤患者以及9例严重外伤后眼睑完全或大部缺损患者。眼睑修复重建后均无功能障碍。其中眼睑恶性肿瘤患者均无复发。结论 组织学控制性切除眼睑肿瘤疗效确切，异体巩膜移植加自体皮瓣移植重建眼睑有利于恢复眼睑的形态和功能，手术效果良好，总有效率达100％。     

部分切除加冷冻治疗眼睑乳头状色素痣及乳头状瘤

乳头状皮肤色素痣及皮肤乳头状瘤都是良性肿瘤,一般不需要治疗。但如果生长在睑缘特别是位在睑缘的中央部位,有时妨碍视线。另外如生长在眼部皮肤上有碍美观,患者常出于美容的目的要求治疗。我们自1982年以来采用部分切除(仅切除肿瘤的隆起部分)加冷冻(冷冻切除后残留肿物的切面)的治疗方法,治疗眼睑乳头状皮肤色素痣及眼部皮肤乳头状瘤,取得了满意的效果。现将治疗后追踪观察三年以上的病例9例报告如下: 手术方法手术方法分两步:     

眼睑分裂痣的手术方式探讨

目的 探讨不同部位和大小眼睑分裂痣的手术方式及效果.方法 回顾性系列病例研究.收集本中心1997年7月至2006年11月的眼睑分裂痣病例共30例(30只眼),按不同部位,侵犯范围的大小分别采取了不同的手术方法.包括:分裂痣切除后直接缝合3例;分裂痣切除后Ⅰ期行游离皮肤移植术5例;分裂痣切除后皮瓣转移术,手术分两期进行,Ⅰ期行上睑或下睑手术,3个月后Ⅱ期行另一眼睑手术,共22例,其中对侵及泪小点的分裂痣将色素痣和受侵犯的泪小点一起切除后行泪小管口再造和睑成形术8例.结果 30例患者随访2～11年,平均随访时间60个月.有1例术后2年复发,随诊5年再次手术,术后病理发现有恶变,经再次行Mohs眼睑恶性肿瘤组织学控制性切除术,术后未见复发.其余病例未见复发和恶变.结论 眼睑分裂痣切除术采用分期手术转移皮瓣法修复眼睑比游离植皮法疗效更满意.对分裂痣切除术后的病例需密切观察,以便早期发现恶变.     

眼睑恶性肿瘤95例诊治分析

目的 回顾性分析眼睑恶性肿瘤的临床、病理学分类以及行Mohs法切除后进行眼睑缺损修复的方法及效果.方法 对近10年来收治的95例(95只眼)眼睑恶性肿瘤进行回顾性分析,其中上睑54例,下睑41例,其中男性46人,女性49人,平均年龄(61.2±16.8)岁(47岁～87岁).所有患者行Mohs法切除后,根据眼睑缺损范围和部位采用不同方法进行眼睑成形或再造.其中66例患者眼睑后层缺损达全长30％～50％,行外眦切开直接缝合;19例患者眼睑后层缺损超过全长50％,分别采用睑板结膜瓣滑行修复、异体巩膜移植修复.采用皮瓣或游离皮片修复眼睑前层缺损;9例患者为眼睑前层缺损,行邻近带蒂皮瓣或游离皮片修补;1例患者眼睑缺损较大仅行带蒂皮瓣转移修复,二期行眼睑再造.结果 95例患者的病理诊断分别为基底细胞癌43例、睑板腺癌30例、鳞状上皮细胞癌16例、恶性黑色素瘤6例.94例患者手术后眼睑完整,形态及功能基本恢复正常;有1例基底细胞癌患者因肿瘤侵及范围较大,术后眼睑畸形明显,6个月后行二期眼睑再造,回复了眼睑基本功能,效果较为满意.所有患者随访10～30个月,有2例患者肿瘤局部复发,无全身转移,经再次手术后均未再复发.结论 眼睑恶性肿瘤多发生于中老年人,其中以基底细胞癌最常见,其次为睑板腺癌和鳞状上皮细胞癌.治疗方法多采取Mohs法切除肿瘤后联合Ⅰ期眼睑缺损修复,达到眼睑形态和功能的恢复.     

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.     

眼睑瘢痕畸形的手术治疗

目的探讨不同类型瘢痕性眼睑畸形的手术方式及治疗效果。方法瘢痕性眼睑畸形10例（15眼）,分别行瘢痕松解及游离皮瓣移植术4例（7眼）,瘢痕松解游离皮瓣移植同时行羊膜移植1例（1眼）,瘢痕松解联合“Z”字皮瓣转位2例（3眼）,瘢痕松解联合带蒂皮瓣转位1例（1眼）;瘢痕松解联合眼轮匝肌蒂皮瓣修复1例（1眼）,瘢痕松解联合睑板楔形切除联合双下眼睑成形术1例（2眼）。结果10例（15眼）手术后获得不同程度满意的外观和功能恢复。结论在眼睑瘢痕修复时,只要能使皮肤缺损和结膜囊完整性得到修复,瘢痕性眼睑畸形恢复眼睑功能及外观,效果良好。     

自体硬腭黏膜移植联合眶周皮瓣修复全层眼睑缺损

目的：评价眼睑恶性肿瘤切除术后采用自体硬腭黏膜移植联合眶周皮瓣进行眼睑再造的临床效果。 方法：患者10例10眼行眼睑恶性肿瘤切除术后重度眼睑缺损,采用硬腭黏膜移植替代眼睑后层,即睑板和睑结膜层,利用眶周皮瓣修复眼睑前层。 结果：术后随访6~12mo,眼睑外观及功能基本恢复正常。硬腭黏膜移植片及转移皮瓣全部成活,无感染、移位、挛缩。 结论：自体硬腭黏膜移植联合眶周皮瓣转移修复全层眼睑缺损,效果肯定。     

Surgical management of deep chemical burns of the eyelids

Chemical burns of the eyelids are common, and this may lead to ocular damage. A direct insult of the eyes that result in permanent damage, is rare in facial burns. The majority of the chemical burns of eyelids are partial-thickness that heal spontaneously in 1 week. Whereas, 10 percent are full-thickness burns that require release of contractures and grafts. Wound contracture can cause ectropion of the eyelid, resulting in exposure keratitis, conjunctivitis, corneal ulcers, perforation, and even blindness. At our departments, thirteen patients with 28 chemical burns of eyelids of third-degree, were reviewed. The eyelids had burns wounds with granulation and necrotic tissue. All patients had severe cicatrical ectropion. The eyelids were released with incisions running along the eyelid margin, down to the orbicularis muscle, including the distal part of the levator palpebrae superioris muscle, when necessary. To cover the resulting defects, we use generous full-thickness skin grafts, if available, for both the upper and lower eyelids. Rarely has a tarsorrhaphy been required, and properly constructed dressing provides satisfactory eyelid margin immobilization and conjunctival hygiene. Eighteen full-thickness grafts in 10 patients are reported 8 to 12 weeks after grafting. In seven eyelids, 3 patients developed ectropion and required reconstruction of the eyelids. Our series demonstrates that the early grafting of eyelid burns with full-thickness grafts, can prevent the development of recurrent cicatrical ectropion. Split-thickness grafting should be limited to cases where we can not find the hairless donor site for full-thickness skin grafts.     

Free tarsal graft combined with skin transposition flap for full-thickness lower eyelid reconstruction

We present the surgical outcome in a series of 4 patients with large full-thickness eyelid defects after basal cell carcinoma excision. The patients underwent reconstructive eyelid surgery using autogenous free tarsal grafts combined with a skin transposition flap from the upper eyelid. Two female and 2 male patients ranging in age from 44 years to 85 years were treated. In all 4 cases, posterior lamellae were reconstructed using a free tarsal graft, and the outer lamella was developed with a transposition skin flap from the upper eyelid. The skin flap provided adequate vascular support in all cases. Follow up of 10 months to 20 months showed a good outcome in all patients. Reconstruction of full thickness eyelid defects after extensive tumor excision requires reforming of the anterior and posterior lamella. Whereas the Hughes or Cutler Beard techniques for eyelid reconstruction require a 2-step approach with occlusion of the eye for at least 1 week, reconstruction with a free tarsal graft is a 1-stage procedure and does not entail eye occlusion. Autogenous tarsus as a free graft proves to be a simple procedure for posterior lamella substitution in lower eyelid surgery, especially in combination with a skin transposition flap from the upper eyelid.     

表浅肌肉腱膜皮瓣联合硬腭黏膜移植修复全层眼睑缺损

目的探讨利用眼周表浅肌肉腱膜系统（SMAS）皮瓣联合硬腭黏膜移植修复中、重度全层眼睑缺损的临床疗效。方法对26例（26只眼）大于或等于眼睑全长1／2的全层眼睑缺损患者,采用硬腭黏膜移植替代眼睑后层,即睑板和睑结膜层;利用眼周血供丰富的SMAS皮瓣修复眼睑前层,即皮肤肌肉层。其中5例采用眼轮匝肌蒂皮瓣,5例为颞浅动脉皮瓣,7例为眉上皮瓣,9例为上睑皮肤轮匝肌双蒂瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眼周的SMAS转位皮瓣,术毕行睑缘缝合3个月。结果全部患者随访6～36个月,平均11个月。转位皮瓣全部成活,硬腭黏膜植片成活好,无收缩,眼睑外观及功能改善较满意。结论眼周SMAS皮瓣联合硬腭黏膜移植可一次性修复缺损的眼睑全层,效果肯定。     

硬腭黏膜移植联合眶周表浅肌肉腱膜系统皮瓣重建全层眼睑缺损

目的:探讨利用自体游离硬腭黏膜植片替代后睑组织联合眶周表浅肌肉腱膜系统(SMAS)皮瓣转移修复缺损的前层眼睑皮肤,重建因肿瘤术后或外伤所致的全层眼睑缺损的临床疗效。方法:对16例≥眼睑全长1/2中重度全层眼睑缺损患者,全部用口腔硬腭黏膜植片替代睑板和结膜,再造后层眼睑;用眶周血供丰富的表浅肌肉腱膜系统(SMAS)皮瓣转移覆盖于硬腭黏膜上,替代缺损的眼睑皮肤肌肉层再造前层眼睑,其中10例采用眼轮匝肌单蒂皮瓣,3例为颞浅动脉皮瓣,2例为上睑皮肤轮匝肌双蒂皮瓣,1例为眉上皮瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眶周的SMAS转移皮瓣,手术完毕行睑缘缝合3～6mo后切开。结果:全部患者随访>12mo,硬腭黏膜植片及其转移皮瓣全部成活,无移位、感染和坏死等不良反应,无收缩,眼睑外观及功能改善满意。结论:硬腭黏膜联合SMAS皮瓣转移修复重建眼睑全层缺损,可以一次性修复眼睑缺损的皮肤、睑板、结膜,疗效肯定,具有较高的临床应用价值。     

眼睑肿物临床病理分析及眼睑缺损修复探讨

目的分析眼睑肿物的临床及病理学分类，探讨手术方法及肿物切除术后跟睑及其周围组织缺损的修复。方法回顾性分析我院73例眼睑肿物基本资料、病理分类、治疗方式、治疗结果，探讨肿物切除术后眼睑缺损个体化修复方式。结果73例（73眼）眼睑肿物中，良性病变62例（84．9％），恶性肿瘤11例（15．1％）。良性病变类型中，以皮样、表皮样囊肿25例，基底细胞乳头状瘤12例，炎性肉芽肿6例，皮脂腺囊肿6例，皮内痣、混合痣5例等为多见。恶性病变中基底细胞癌9例，鳞状细胞癌2例。73例眼睑肿物均行手术切除，切除后眼睑缺损修复方法有：44例直接缝合切缘皮肤，15例游离松解切缘皮肤后对位缝合，5例取左上臂内侧皮肤植皮修复，7例行颧颞部皮瓣移植修复，1例行鼻唇沟皮瓣移植修复，1例行滑行睑板结膜瓣修复，植皮及皮瓣移植均成功存活，疗效良好。恶性肿瘤随访期间尚未见转移。结论眼睑肿物中良性病变多于恶性病变，恶性病变中以基底细胞癌最为常见，手术切除是治疗的有效方式，术后眼睑缺损的个体化修复重建在维持眼睑形态、防止眼睑畸形、保护眼表功能方面具有重要意义。     

Results following free skin transplantations

The present paper reports on the technique and results of free full-thickness skin grafts after tumor excision in 23 cases. The functional and cosmetic results were good or even excellent. No ischemia or shrinkage of the grafts was observed. The difference in color between the graft and the surrounding skin disappeared within months. The author recommends free skin grafting in particular for defects of the inner canthus, where the results obtained are much better than those achieved with the Fricke operation, which are cosmetically poor.     

Clinical features, surgical outcomes and genetic analysis of ectodermal dysplasia with ocular diseases

AIM: To report on the clinical features, surgical outcomes and gene mutation analysis of three ectodermal dysplasia probands with ocular diseases. METHODS: A case-note review of three unrelated probands diagnosing with ectodermal dysplasia with ocular diseases was undertaken. Patient clinical features and the outcomes of surgery were analysed. The suspected pathogenic genes were analysed by whole exome sequencing from patients with ectodermal dysplasia and Sanger sequencing from family members. RESULTS: The ocular clinical features of ectodermal dysplasia with ocular diseases mainly include eyelid ectropion, lagophthalmos and absence of lacrimal punctum. All the probands underwent surgeries of full-thickness free skin flap grafting to correct ectropion. They achieved good recovery, and there were no obvious complications during the follow-up. The gene sequencing results did not show any meaningful genetic mutations. CONCLUSION: Lid ectropion is one of the key clinical traits of ectodermal dysplasia with ocular diseases. Ectropion correction with full-thickness free skin flap grafting is an effective procedure to correct ectropion for ectodermal dysplasia patients with ichthyosis-like tissue. The suspected pathogenic genes of ectodermal dysplasia with ectropion should be further verified or confirmed by large samples of the family.     

风筝皮瓣修复眼睑前层及中面部皮肤缺损

目的 评价风筝皮瓣修复合并或不合并中面部皮肤缺损的眼睑前层缺损的疗效.方法 自2008年1月至2010年3月,以面部皮下组织为蒂,设计"风筝"皮瓣,联合或不联合硬腭黏膜移植,修复合并或不合并中面部皮肤缺损的眼睑缺损共10例.眼睑前层或和中面部皮肤缺损面积为(1.2～6.5)cm2、(0.7～4.0)cm2.其中下眼睑中央水平方向4/5、垂直方向完全全层缺损合并颧颊部皮肤缺损1例,下睑内侧水平方向1/2、垂直方向完全全层缺损、下泪小点下泪小管缺损合并中面部皮肤缺损1例,下睑水平及垂直方向均完全全层缺损合并下泪小点及下泪小管缺损1例,上下睑水平方向完全、垂直方向1/3全层缺损合并上下泪小点泪小管缺损1例,下睑中央水平方向4/5、垂直方向完全全层缺损合并颧颊部皮肤缺损1例,全上眼睑前层及颞部皮肤缺损1例,下睑内侧水平方向1/3、垂直方向1/5前层缺损1例,上下睑中央水平方向2/3、上睑垂直方向1/3,下睑垂直方向2/3全层缺损1例,上下睑内侧1/3前层及内呲内侧皮肤缺损合并上下泪小点缺损1例,外眦外侧前层及颞部皮肤缺损1例.结果 皮瓣均无张力修复缺损,皮瓣及硬腭黏膜均全部成活,眼睑外形、功能完全恢复.结论 风筝皮瓣是修复眼睑缺损及面部皮肤缺损的良好方法.

Abstract：

Objective To evaluate the effect of rehabilitating the anterior 1amella of eyelids and midfacial skin defects with kite flap.Methods From January 2008 to March 2010,with or without combination of a hard palate mucosal grafts,the kite flap on a subcutaneous pedicle have been used to repair defect in the anterior lamella of eyelids and midfacial skin in 10 patients.The area of the defect in the anterior lamella of eyelids and midfacial skin ranged from(1.2～6.5)×(0.8～4)cm.Among them,defects span central 4/5 in horizontal direction and complete in vertical direction in full-thickness lower eyelid and partes zygomatica skin in 2 patient,medial 1/2 in horizontal direction and complete in vertical direction and puncta and canaliculus in full-thickness lower eyelid and midface skin in 1 patient,complete lower eyelid and inferior puncta and canaliculus in 1 patient,complete in horizontal direction and 1/3 in vertical direction and puncta and canaliculus both in full-thickness upper and lower eyelids in 1 patient,complete anterior layer of upper eyelid and temples skin in 1 patient,medial 1/3 in horizontal direction and 1/5 in vertical direction in the anterior lamella of lower eyelid in 1 patient,central 2/3 in horizontal direction and 1/3 in vertical direction in full-thickness upper eyelid,and central 2/3 in horizontal direction and 2/3 in vertical direction in full-thickness lower eyelid in 1 patient,medial 1/3 of anterior lamella and puncta and canaliculus both in upper and lower eyelid and inside skin of medial canthus in 1 patient,outside skin of outer canthus and temples skin in 1 patient.Results All flaps and hard palate mucosal grafts were survived.All defects were repaired without tention.The cosmetic appearance and function of eyelids rehabilitated.Conclusions The kite flap provides a competitive method for repairing the anterior lamella of eyelids and facial skin defects.     

60例眼睑全层裂伤的临床特征和急诊手术方法

目的探讨急诊眼睑全层裂伤的病因、临床特点、手术方法及效果。设计回顾性病例系列。研究对象北京同仁医院眼科急诊的60例（60眼）眼睑全层裂伤患者。方法询问病史，详细眼科检查。应用垂直褥式、水平褥式和三缝线缝合法修复眼睑全层裂伤。对伴有泪小管断裂、内外眦韧带离断、眼睑皮肤缺损、眼睑全层缺损、提上睑肌断裂者，还需行泪小管断裂吻合、内外眦韧带复位、提上睑肌断裂缝合复位、皮肤缺损及眼睑缺损修复术。主要指标眼睑形态，日艮睑位置，眼睑运动功能，吻合后的泪小管是否通畅。结果眼睑全层裂伤病因主要是车祸伤、外物击伤、坠落伤、动物咬伤。眼睑裂伤多伴有泪小管断裂、内外眦韧带离断、眼睑皮肤及全层缺损、提上睑肌断裂。急诊手术后随访6～12个月，绝大部分患者术后眼睑外观形态、眼睑闭合以及运动恢复良好，38例（95％）泪小管吻合术后保持通畅。结论车祸伤和外物击伤是急诊眼睑全层裂伤的主要原因，及时、正确、细致地手术处理可使大部分眼睑裂伤在Ⅰ期得到良好的修复，同时也为少部分患者Ⅱ期整复做好准备。