异体巩膜移植替代睑板重建眼睑

目的 探讨异体巩膜移植替代睑板重建眼睑的临床效果。方法 1986年5月～2001年1月对45例部分眼睑缺损患者，采用异体巩膜替代睑板行眼睑重建。其中男31例，女14例，上睑18例，下睑27例；累及上或下眼睑内眦都9例，外眦都7例，眼外伤22例，眼睑肿瘤23例。眼睑缺损不超过眼睑总长度的1／2。术后观察重建眼睑的外观、功能及并发症。结果 45例移植异体巩膜行眼睑重建均获成功。术后随访11～38个月，平均19．7个月。重建的眼睑完整，双侧眼睑长度及高度差值均小于2mm。眼睑开闭及上提功能基本正常，对视功能无影响。结论 异体巩膜是替代睑板行眼睑重建的理想材料。     

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     

眼睑恶性肿瘤切除术后自体硬腭黏膜移植眼睑再造

目的 眼睑恶性肿瘤切除术后采用自体硬腭黏膜替代眼睑后层进行眼睑再造，并对其临床效果进行评价。方法1998年1月～2003年10月，对18例（18眼睑）患者行眼睑恶性肿瘤切除术后，局部旋转移位皮瓣或游离皮瓣联合自体硬腭黏膜替代眼睑后层的眼睑再造术。其中男10例，女8例，年龄35～67岁。18例均为重度眼睑缺损，其中眼睑全部缺损12例，2／3眼睑缺损6例。眼睑基底细胞癌10例，睑板腺癌6例，眼睑鳞状细胞癌2例。结果18眼睑术后外观及功能基本恢复正常，闭合完全，无内外翻。术后随访6个月～4年，平均3年2个月，眼睑形态及功能保持稳定，无植片感染及挛缩，无免疫排斥反应，无肿瘤复发。结论自体硬腭黏膜代替眼睑后层作眼睑恶性肿瘤切除术后的眼睑重建术，是一种简便易行、取材方便、术后并发症少、临床效果满意的眼睑再造术，硬腭黏膜优于传统的眼睑后层替代材料。     

150例眼睑缺损的手术修复

目的 探讨各种原因致不同程度眼睑缺损、畸形修复的有效方法.方法 收集自2010年2月至2013年2月,因各种原因所致不同程度眼睑缺损的患者150例150眼,对其临床资料进行回顾性分析.对眼睑缺损范围＜睑裂长度1/4者72只眼,＞1/4或＜1/2者57只眼,＞1/2者21只眼,分别采用直接拉拢缝合法,联合滑行、转位、游离皮瓣修复眼睑缺损.结果 术后随访1～24个月,1例因恶性肿瘤复发而再行肿瘤切除术后,发生下睑退缩致闭合不全,其余149例均获Ⅰ期愈合,眼睑局部皮瓣全部成活,眼睑形态良好,睑缘位置正常,眼睑功能正常.结论 对各种原因所致眼睑缺损、畸形的患者,采用不同眼睑重建方法,灵活应用异体巩膜、结膜、黏膜等生物材料及各种皮瓣转移法修复缺损创面,可有效恢复眼睑的结构和形态,值得临床推广应用.     

Can Aesthetic Facial Reconstruction Be Judged in Black and White?

Aesthetic considerations of the face need to be evaluated in real-life full color. Staged contouring and insetting of a transferred free flap is sometimes required. This consists of debulking, thinning, and reshaping the flap. If the facial area is involved, however, color mismatch of a free flap represents an aesthetic challenge for the reconstructive surgeon, and often is missed with black and white photos.This article reports on a patient in whom a first dorsal metatarsal cutaneus free flap was used to reconstruct a full-thickness defect in the lateral orbit including upper and lower eyelids and outer canthus. The flap resulted in an unacceptable aesthetic outcome consisting of a bulky, hypopigmented deformity. Revisional surgery consisted of debulking the free flap and resurfacing it with a full-thickness skin graft taken from the postauricular area. This resulted in a pleasant, thin, and better color match reconstruction.The advantages of the first web space of foot free flap to the eyelid are well described. The authors are of the opinion that the flap does not match the color of the eyelid region, and therefore suggest that if used, prefabrication or a second procedure is needed.Evaluation of the postoperative results needs to be in color because black and white can mask the final aesthetic result.     

Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns

OBJECTIVE: To evaluate the efficacy of eyelid reconstruction with acellular dermal allograft in patients with eyelid defect after chemical and thermal burns. METHOD: Eyelid reconstruction was performed in 15 eyelids of 13 patients during the period of June 2001-October 2004 by a single senior surgeon (Chen). Among them five patients had thermal burns, and eight patients had chemical burns. The acellular dermal allograft was used as a tarsus substitute that was sutured into the place between the levator aponeurosis in upper lid or retractor in lower eyelid and the remaining tarsus. RESULTS: After a mean follow-up of 9 months, satisfactory function and cosmesis were obtained. No implant rejection or severe complications were observed. CONCLUSION: Acellular dermal allograft may be used safely as a posterior lamellar spacer graft after chemical and thermal burns; the allograft appears to be biocompatible and does not aggravate the inflammation in the injured eyelid.     

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.     

Use of the free prefabricated temporoparietal fascia-chondro-cutaneous flap nourished by only arterial inflow: an arterial flap

Summary Pedicled temporoparietal fascial flaps have been used extensively in head and neck reconstruction for many years. Also, the fascia has been grafted, and the skin graft transformed into a vascularized pedicled flap (prefabricated temporoparietal fasciocutaneous flap). On the other hand, some authors have used free temporoparietal fascial flaps for defects that require to be filled in lower and upper extremity wounds. In this case, a free prefabricated temporoparietal fascio-chondro-cutaneous flap having only an arterial inflow was used in eyelid reconstruction.Presented at the 14th Congress of Turkish Plastic and Reconstructive Surgery, Ankara, Turkey, October 1992     

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.     

Microvascular Surgery

Methods of anastomosing small blood vessels are presented, together with an account of the authors' own experiences in the field of microvascular surgery. Practical suggestions are made to avoid pitfalls. The modern literature on experimental and clinical applications of microvascular technique in plastic and reconstructive surgery is reviewed. An extensive bibliography is offered as an aid to the interested reader.     

Total upper eyelid reconstruction

Total upper eyelid reconstruction is required infrequently and is a challenge following trauma or the removal of eyelid for tumor. The vertical forehead flap can provide the external lamella with a mucous membrane graft lining its posterior surface. Two cases of total upper eyelid reconstruction using this method are presented and discussed. Received: 10 August 1998 / Accepted: 19 November 1998     

Functional outcomes of upper eyelid blepharoplasty: A systematic review

Objective

Various functional outcomes after upper blepharoplasty are reported in the literature. We systematically reviewed the literature to assess the objective and subjective functional effects of upper blepharoplasty.

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     

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。