Full-thickness eyelid reconstruction with a single upper eyelid orbicularis oculi musculocutaneous flap

Eyelid tumors affecting the eye in general prove to be highly challenging to plastic surgeons. Reconstruction must be precisely detailed when dealing with lesions that primarily affect the skin but progressively the eyelid margin. Conjunctiva invasion damage is estimated to one-third or less in size when compared with the damage caused on the anterior wall of the eyelid. Although serial techniques for extent and location of full-thickness eyelid reconstruction have been detailed, the orbicularis oculi muscle can be easily raised as an island musculocutaneous flap. The eyelid's bilaminar wall is recreated by folding the flap on itself and full-thickness eyelid reconstruction is achieved sacrificing minimal accessory tissue. The small cutaneous section in contact with the globe becomes tolerable. As no single method for full-thickness eyelid reconstruction applies to extent and location to a wide range of defects, the proposed flap is safe, reliable, and beneficial to oculoplastic surgery.     

Cervicofacial rejuvenation, orbicularis oculi muscle and platysma]

The structural rejuvenation has two goals: the treatment of the face and neck area as a whole, and the building up of the facial features. By treating the neck from the mandible to the "decolleté" (the clavicular region), the first goal gives harmony. It avoids a too smooth face being the cover up of a wrinkled turtle neck. The second goal tries to produce nature beautiful faces, instead of the "Barbie dolls" faces with their unfortunately well-known ageless flat blank look. It is then necessary to manage the two kinds of structural defects, the youth's and the aging ones. The first ones are the lack of the anterior cervical angle, malar, chin hypogenesia. The second ones are the vanishing of the structural features of the youth. Treating each layer separately, working with the grain or on the cross according to the tissues and the goal, gives a youthful and natural look. Just lifting them up provides a flat face, the same way spreading a sheet over an object flattens it. On the contrary turning around it produces a good enhancement. To obtain this result the author privileges two muscles, the platysma and the orbicularis oculi muscle. She uses them in the same way to treat not only the area, but the slackness of the muscles themselves. The author updates her first technique: the double flap cervical platysmaplasty (DFCP). Then, she describes the two versions of the orbicularis oculi plasty: simple or in association with the DFCP. She works with the orbicularis flaps as if they were the reins of a horse. She pulls them around turning points. She obtains some of them by not undermining the skin as for the "malar turning point". She makes the others by suturing the flaps to the fascia at specific points. The results over 500 cases, some of them 4 years old, rate good. The report shows no complications, particularly no permanent neither transient palsy.     

眼轮匝肌蒂皮瓣修复睑皮肤缺损

探讨使用一种血供确实可靠、即时移转的皮瓣修复眼睑皮肤缺损。方法　采用以眼轮匝肌为蒂的颧部、颞部皮瓣修复同侧上睑或下睑皮肤缺损。结果　修复上睑或下睑挛缩瘢痕切除松解后创面 (8例 )、色素痣切除后创面 (4例 ) ,取得满意效果。结论　以眼轮匝肌为蒂的皮瓣具有确实可靠的血供、易于移转和供区可以直接缝合等优点 ,是一种修复眼睑皮肤缺损可供选用的方法。     

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。     

应用眼轮匝肌蒂皮瓣修复瘢痕性下睑外翻

目的：探讨应用眼轮匝肌蒂皮瓣修复瘢痕性下睑外翻的方法及效果。方法：设计以眼轮匝肌为蒂的颞侧或鼻侧皮瓣，将皮瓣分别旋转180°或90°，覆盖眼睑部瘢痕松解后形成的创面，修复睑外翻。其中应用眼轮匝肌蒂颞侧皮瓣修复下睑外翻34例，皮瓣最大面积1．8cm×2．8cm；应用眼轮匝肌蒂鼻侧皮瓣修复下睑外翻6例，皮瓣最大面积0．7cm×1．8cm。结果：本组患者40例，皮瓣均完全成活，随访6—12个月，睑外翻无复发，供区瘢痕不明显。结论：眼轮匝肌蒂皮瓣转移方便，血供良好，色泽协调，是修复瘢痕陛下睑外翻的良好选择。     

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.     

应用睑板前眼轮匝肌瓣转移填充法矫正重睑术后上睑凹陷

目的:探索重睑术后上睑凹陷畸形矫正的新方法。方法:本组8例,均为女性,均采用眼轮匝肌瓣转移填充矫正重睑术后上睑凹陷。结果:对8例患者术后随访1~2年,术后上睑无明显凹陷,新形成的重睑自然美观。结论:眼轮匝肌瓣转移填充法是一种矫正重睑术后上睑凹陷、多重睑的较好方法。     

颞侧眼轮匝肌蒂皮瓣修复眼睑缺损

目的：探讨以眼轮匝肌为蒂的颞区皮瓣修复眼睑缺损的临床应用。方法：在颞侧设计眼轮匝肌为蒂的皮瓣,将皮瓣向内推进或旋转1800修复睑缺损区。结果：7例眼睑缺损修复均取得了满意的效果,未出现并发症。结论：眼轮匝肌蒂颞区皮瓣修复眼睑缺损比局部或皮下蒂组织瓣易于移转,修复后外形满意且供区隐蔽,是修复眼睑缺损的良好选择。     

重睑成形术同时行眼轮匝肌肌皮瓣转移治疗轻度瘢痕性上睑外翻

目的探讨轻度瘢痕性上睑外翻的患者,如何在行同侧重睑成形术时,应用上睑眼轮匝肌肌皮瓣旋转后进行修复。方法行重睑成形术时,利用可去除的松弛皮肤及其深面的眼轮匝肌制成肌皮瓣,修复外翻松解复位后遗留的缺损创面。结果2003年2月至2005年12月,共修复轻度瘢痕性上睑外翻13例13只眼,除1例因蒂部略显臃肿,6个月后再次修整外,其余皮瓣外观平整自然,随访2周至6个月,效果满意。结论将重睑成形术中可去除的松弛皮肤及深面的眼轮匝肌重新利用,制成的眼轮匝肌肌皮瓣血运丰富,长宽比例最大可达6∶1,且转移灵活,供区切口隐蔽在重睑皱襞形成线上,无供区瘢痕。     

Use of orbicularis oculi muscle flap for undercorrected blepharoptosis with previous frontalis suspension.

The frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the level of the eyebrow. Therefore, the superiorly based orbicularis oculi muscle flap, when advanced and attached to the tarsal plate, can dynamically elevate the upper lid and correct blepharoptosis with previous frontalis sling. Six patients with undercorrected blepharoptosis after frontalis sling suspension were included in this study. The superiorly based orbicularis oculi muscle flap was advanced to the tarsal plate in these patients and the redundant portion of the distal flap was resected. Postoperative results were satisfactory after 1-year follow-up.     

眶脂肪保留和眼轮匝肌瓣悬吊法整复睑袋畸形

目的预防睑袋整复术后出现下睑凹陷和巩膜过多显露等并发症。方法术中沿眶下缘松解眶隔,释放出眶脂肪,将其充填眶下缘凹陷,并设计下险眼轮匝肌瓣,用以缩紧悬吊松弛下垂的下睑肌肉与皮肤。结果从1996年9月至1997年5月,共以此法整复睑袋畸形30例。26例得到3～8个月随访,除1例因一侧眼轮匝肌瓣固定不牢致下睑轻度外翻外,其余均获满意效果。结论此法既可有效地矫正睑袋畸形,又可避免术后出现下睑凹陷和巩膜过多显露状况,同时具有颊提升效果,可使全中面部变得年轻化。     

眶脂肪保留和眼轮匝肌瓣悬吊法整复睑袋畸形

目的预防睑袋整复术后出现下睑凹陷和巩膜过多显露等并发症。方法术中沿眶下缘松解眶隔,释放出眶脂肪,将其充填眶下缘凹陷,并设计下睑眼轮匝肌瓣,用以缩紧悬吊松弛下垂的下睑肌肉与皮肤。结果从１９９６年９月至１９９７年５月,共以此法整复睑袋畸形３０例。２６例得到３～８个月随访,除１例因一侧眼轮匝肌瓣固定不牢致下睑轻度外翻外,其余均获满意效果。结论此法既可有效地矫正睑袋畸形,又可避免术后出现下睑凹陷和巩膜过多显露状况,同时具有颊提升效果,可使全中面部变得年轻化。     

中老年重睑成形术——眼轮匝肌浅面埋线法

目的为减轻中老年人重睑成形术后的肿胀和缩短恢复时间,介绍一种新的中老年重睑成形术的方法。方法首先去除松弛皮肤,然后在眼轮匝肌浅面作埋线缝合,在切除上睑松弛皮肤时,不损伤皮下静脉血管,术中无须去除眼轮匝肌,然后缝合皮肤。结果本组432例患者,术中出血少,术后肿胀轻微,恢复较快,随访2周至10个月,效果满意。结论该手术方法可作为中老年重睑成形术的选择性术式之一,操作简便,手术时间短,效果可靠。     

中老年重睑成形术--眼轮匝肌浅面埋线法

目的为减轻中老年人重睑成形术后的肿胀和缩短恢复时间,介绍一种新的中老年重睑成形术的方法.方法首先去除松弛皮肤,然后在眼轮匝肌浅面作埋线缝合,在切除上睑松弛皮肤时,不损伤皮下静脉血管,术中无须去除眼轮匝肌,然后缝合皮肤.结果本组432例患者,术中出血少,术后肿胀轻微,恢复较快,随访2周至10个月,效果满意.结论该手术方法可作为中老年重睑成形术的选择性术式之一,操作简便,手术时间短,效果可靠.     

应用携带眼轮匝肌的斧形皮瓣修复眼睑分裂痣

目的：探讨应用携带眼轮匝肌的斧形皮瓣修复眼睑分裂痣的方法及效果。方法：设计位于外眦部的携带部分眼轮匝肌的斧形局部旋转皮瓣,修复切除眼睑分裂痣后形成的创面。其中病变范围最小为0.4cm×1.5cm,最大为1.5cm×3.8cm。结果：本组患者16例,术后皮瓣均完全成活。12例患者随访6～12个月,切除区域的痣无复发,皮瓣颜色与周围皮肤一致,瘢痕轻微,效果满意。结论：应用携带部分眼轮匝肌的斧形局部旋转皮瓣修复眼睑分裂痣手术操作方便,血供良好,色泽协调,是修复眼睑分裂痣的良好选择。     

双层眼轮匝肌瓣及眶隔固定的睑袋整复术

目的:探讨睑袋整复术的简便而有效的手术方法。方法:对83例睑袋患者进行双层眼轮匝肌瓣及眶隔固定的睑袋整复手术。结果:所有患者均没有出现眼睑外翻等并发症,睑袋消失,眶区年轻化。结论:采用双层眼轮匝肌瓣及眶隔固定的睑袋整复手术修复,方法可靠,患者满意。