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。     

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     

上睑滑行睑板结膜瓣联合颧颊部皮下蒂肌皮瓣修复下睑缺损

目的 探讨下眼睑全层缺损的手术治疗方法及疗效.方法 对6例下眼睑恶性肿瘤患者采用Mohs控制性切除术,利用上睑滑行睑板结膜瓣修复下睑后层缺损,颧颊部皮下蒂肌皮瓣修复下睑前层缺损.术后6周分离睑板结膜瓣,结果本组患者术后均随访3～6个月,无上睑退缩,下睑外翻及兔眼形成,外形、视觉功能良好,肿瘤无复发.结论 上睑滑行睑板结膜瓣联合颧颊部皮下蒂肌皮瓣修复下睑缺损是治疗下睑全层缺损的有效方法.     

Reconstruction of a lower eyelid defect using the temporalis muscle

Massive defects of the cheek and simultaneous involvement of both eyelids preclude the use of local flaps and standard techniques for total lower eyelid replacement. Regional flaps may not provide enough coverage nor bulk, or they may require multiple delay procedures. Sagittal splitting of the temporalis muscle and anterior rotation of its lateral head deserves consideration for reconstruction of uncommon, large periorbital defects. A case is presented in which globe salvage was possible using this technique as a single stage procedure.     

Total upper and lower eyelid reconstruction using deltopectoral flap

Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results.KEY WORDS: Deltopectoral flap, total eyelid reconstruction, total upper and lower eyelid reconstruction with DP flap     

Correction of ectropion of the lower lid by upper eyelid skin transposition

A technique for the correction of ectropion of the lower lid by transposition of a full-thickness skin flap from the ipsilateral upper eyelid to the lower lid has been used in seven patients. The technique allows great flexibility in the extent of the approximation of the lower lid to the eye globe. The pedicle is based medially to obtain close contact between the lower punctum and the eye globe. There were no complications. We believe that the eyelid skin flap transposition technique is a useful operation for the correction of moderate to severe senile and paralytic ectropion.     

重塑下睑曲线的下睑成形术

目的 探讨重建下睑曲线的下睑成形方法,以有效改善下睑老化.方法 释放眶脂体,加强固定眶隔膜的同时,固定下睑支持韧带,重建笑台,固定锚着外眦处睑板前组织,固定真皮瓣.结果 本组65例患者,2例出现球结膜水肿,治疗1周后消退;1例眶缘处硬结,热敷1个月后消失.所有患者随访3～6个月,效果满意.结论 重塑下睑曲线的下睑成形术,在有效解决下睑老化的同时可重塑眼部生理曲线,使眼部更年轻.     

睑袋整复术后下睑退缩的矫正

目的：探讨矫正睑袋整复术后并发的下睑退缩的理想方法。方法：对5例（8只眼）下睑退缩较轻者，单纯施行经眦眦固定术缩紧外眦腱使下睑缘上移复位；对15例（27只眼）下睑退缩较重者，施行经眦紫固定术同时行Hamra释放弓状缘和保留眶脂肪的下睑成形术，以在缩紧外眦腱的同时松解下睑眶隔和眶脂肪层的瘢痕挛缩，悬吊眼轮匝肌及提升中面部皮肤补充下睑前层不足。结果：术后14例（25只眼）得到6－12个月的随访，除1例（1只眼）较重的下睑退缩矫正不全外，其余均获得满意效果。结果：①经眦眦固定术是矫正轻度下睑退缩简单而有效的方法；②施行经眦眦固定术同时行Hamra下睑成形术是矫正较重度下睑退缩的理想选择。     

上下眼睑同时退缩(突眼症)整复术

目的 探讨上下眼睑同时退缩畸形简单高效整形方法的可行性和疗效.方法 通过下睑睫毛延长切口,松解、切断下睑缩肌,并将外眦韧带、外侧眶隔向外及下睑眼轮匝肌向外上侧紧缩,上睑眼轮匝肌向外下牵拉、固定,增加使睑裂宽度缩小的肌筋膜系统的张力及闭目的 动力,以矫正上下眼睑同时退缩的外观畸形.结果 本组7例患者,术后每只眼睑裂宽度平均缩小3.6mm,随访3～25个月,无复发,效果均满意.结论 本手术操作简单,创伤小,疗效可靠,术后肿胀轻、恢复快,值得临床推广.     

Total upper and lower eyelid reconstruction using an expanded forehead flap

Surgical modalities have been described with varying success for the correction of eyelid defects. The reconstructive surgeon must choose the procedure on a case-by-case basis taking into consideration the following criteria: mechanism of injury, comorbidities, and goals of surgery. In this study, we describe a unique case of total upper and lower eyelid reconstruction using an expanded forehead flap technique in an adult patient who underwent left eye enucleation and radiation to the orbit for rhabdomyosarcoma in infancy. After this patient reached adulthood, examination revealed a contracted, anophthalmic left orbit with paper-thin upper and lower eyelids adhering to the concave walls of the orbit. There was absence of significant periorbital soft tissue. The expanded forehead flap procedure achieved our aims of providing not only an aesthetic result, but also adequate soft tissue support for placement of an ocular prosthesis.     

Anthrax of the lower eyelid

Because cutaneous anthrax, caused by Bacillus anthracis, is rare in developed countries, sporadic cases of anthrax may easily be overlooked because the diagnosis is often difficult to make. Lower eyelid involvement of anthrax is rare in clinical practice.A 40-year-old woman with a history of contact with animals was evaluated and treated for a left lower eyelid lesion with a black eschar on it. A diagnosis of cutaneous anthrax had been made and intravenous penicillin had been given by the department of infectious diseases before plastic surgery consultation. Any kind of surgical intervention was delayed for three months. The lesion healed secondarily and the resulting scar did not result in ectropion of the lower eyelid.Delaying surgery is preferred because it is a safer approach when dealing with anthrax involving the lower eyelid, and secondary healing does not always result in deformity compromising function.     

保留下睑缘轮廓的睑袋整复术

目的:探讨一种保留下睑缘轮廓线的睑袋整形术.方法:在下睑睫毛下2～3mm处作切口,经轮匝肌下入路去除膨出眶脂和松弛皮肤,缩短眼轮匝肌悬吊于外眦,收紧眶隔,上移眼轮匝肌重叠缝合,重建下睑缘轮廓线.结果:350例患者均获良好效果,下睑缘轮廓自然.5例早期出现睑外翻,术后1月随访时外翻情况已消失,情况满意.结论:保留下睑缘轮廓的睑袋整形术能获得更好的术后效果.