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     

Modified gate flap for lower lip reconstruction

Summary One of the latest techniques advocated for total lower lip reconstruction is thegate flap described by Fujimori in 1980 [3]. This technique has been modified and used in two patients. With this modification, it is no longer necessary for the lateral margins of resection to extend beyond the commissure for technical purposes, and the shape of the resection does not have to be rectangular. Thus, unnecessary resection of normal tissue and macrostomia are prevented. Widely used reconstruction techniques for large lower lip defects were compared and an attempt was made to explain how to choose the proper technique for a given defect.     

应用颞浅动脉额支岛状皮瓣修复下睑基底细胞癌切除后创面

目的 探讨下睑基底细胞癌的治疗方法。方法 术前用超声多普勒测定并标记颞浅动脉及其额支的走行方向。术中距病损边缘0．5～1.0cm切除病变组织，并送冰冻切片检查，以确定病变的性质及是否切除彻底。据术前标记设计额部皮瓣，皮瓣应大于缺损0．5cm，蒂长大于蒂到缺损区1．0～1．5cm，宽约3cm。累及眼睑全层的缺损，将结膜游离后上拉与皮瓣缝合，或将皮瓣设计足够大，将皮瓣边缘修成全厚皮，翻转后与结膜缝合。供区创面较大，可考虑皮片移植修复。结果 本组5例，均行额部岛状皮瓣修复，术后无下睑缺损及外翻。结论 应用颞浅动脉额支岛状皮瓣修复下睑基底细胞癌切除后创面，效果良好。     

Expanded forehead (Fricke) flap for large defect of lateral canthal area

Summary The use of an expanded forehead (Fricke) flap to repair large full thickness defects of the lateral canthus and/or of the upper eyelid is presented. The reconstruction is performed in two stages. In the first stage, a rectangular, 25 ml tissue expander (6 cm in width and 2 cm in length) is inserted under the skin lateral to and above the eyebrow; expansion is completed in about three weeks. At the second stage, the lesion is excised, and the laterally based expanded flap is elevated. Using the expanded Fricke flap, thinner, abundant skin is obtained, and the donor site is directly closed, without grafting and without distorting the eyebrow. If there is a shortage of conjunctiva, this can be reconstructed with the capsule of the expanded flap. The result is functionally and aesthetically satisfactory. This technique has been used on six patients following tumour resection in the lateral canthal area. This method is proposed as an alternative to other flaps, which can be used to reconstruct the lateral canthus, and which often gives unsatisfactory final results.Presented as poster to the 2nd International Symposium on Reconstructive Surgery of the Orbit and its Adnexa, June 9–12, Rotterdam     

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。     

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.     

眼睑局部皮瓣在修复睑缘色素痣切除后创面中的应用

目的：介绍睑缘色素痣手术切除后创面修复的方法。方法：根据睑缘色素痣切除后眼睑缺损创面的层次、大小及形状,选用适当的眼睑局部皮瓣修复睑缘缺损,如：＂A-T＂皮瓣、＂风筝＂皮瓣、＂H＂形推进皮瓣。共施行手术38例,其中缺损创面位于上睑缘者23例,下睑缘者15例;睑缘全层缺损9例,睑缘前层皮肤缺损29例;睑缘缺损面积最小者约为0.5cm×0.6cm,最大者约为1.6cm×0.8cm。共利用＂A-T＂皮瓣16例、＂风筝＂皮瓣13例、＂H＂形推进皮瓣9例。结果：本组患者术后皮瓣全部成活,切口均Ⅰ期愈合,其中33例术后获得随访1周～16周,眼睑外观形态良好,眼睑切口无明显瘢痕,睑缘弧线正常自然,双眼睑形态对称,眼睑闭合功能正常。结论：睑缘色素痣因其位置的特殊性,灵活选用眼睑局部皮瓣修复睑缘缺损,能获得满意的眼睑功能和美容性重建效果。     

应用扩张皮瓣修复下眼睑外翻

目的探讨利用皮肤软组织扩张技术,修复各种原因所致下眼睑外翻。方法利用皮肤扩张器对40例各种原因所致下眼睑外翻患者行后期整复治疗,扩张器容量最小30ml,最大150ml;扩张时间2～3个月,扩张满意后面部皮肤以局部皮瓣旋转或推进整复下眼睑外翻。结果40例患者疗效基本满意,随访2年未见复发,其中2例因皮瓣局部臃肿行修薄术,扩张皮瓣色泽及质地均接近正常皮肤。结论在下眼睑外翻的后期整复中,合理应用皮肤软组织扩张技术可以取得较好的治疗效果,供区切口隐蔽,而且不易复发。     

双V形切口法Ⅰ期内眦赘皮矫正及重睑成形术

目的探讨一种伴有内眦赘皮单睑者于行切开重睑成形术的同期进行内眦赘皮矫正术,使内眦部位瘢痕隐蔽的一项手术方法。方法设计内眦横行切口线、重睑线和下睑弧形切口线。横行剪开内眦皮肤的长度达新设计的内眦点,纵行剪开部分内眦韧带前脚,将内眦韧带前脚的内眦侧断端向鼻侧牢固地固定在鼻背筋膜上。常规行切开重睑成形术,去除新内眦上端多余小三角形皮肤及下方部分片状眼轮匝肌。沿下睑缘距睫毛下1～2mm处向颞侧弧形切开达下睑“猫耳”消失处,向下分离内眦下方下睑皮瓣,剪除赘皮和部分眼轮匝肌。缝合皮肤,使术后瘢痕隐蔽,睑裂增大,赘皮消失。结果23例46只眼,睑裂增大2～4mm,内眦赘皮消失,重睑形成,内眦部位瘢痕隐蔽,外形满意。结论手术方法简单,内眦部位瘢痕隐蔽,可与切开法重睑成形术同期进行,除2例半年至1年内内眦瘢痕轻度增生外,余均取得满意的疗效,尤其适合于严重的正向型和倒向型内眦赘皮的手术矫正。     

瘢痕皮瓣修复上睑皮肤瘢痕性缺损

目的：探讨局部瘢痕皮瓣修复上睑皮肤瘢痕性缺损的效果。方法：烧伤、感染后的瘢痕疙瘩所致上睑皮肤瘢痕性缺损10例;采用保留瘢痕皮肤的瘢痕内剥除塑形手术方法,同时松解复位外翻的眼睑,术后曲安奈德瘢痕内注射2～5次。结果：除1例皮瓣坏死改善不明显外,其余病例瘢痕疙瘩和睑外翻完全矫正。随访3～12月,无复发,重睑形态良好。结论：瘢痕皮瓣是修复上睑皮肤瘢痕性缺损的良好办法。     

The lateral arm free flap in lower extremity reconstruction

Reconstruction of skin defects of the distal third of the leg and foot is often a difficult task. Shape, resistance to shearing stresses in the weight-bearing surface and sensibility are the main features that have to be restored. For coverage of this region, the authors have used, in selected patients, the lateral arm flap (LAF) since 1994. This flap is thin, easy to dissect and has the possibility to be innervated through the posterior cutaneous nerve of the arm. Fourteen cases are presented. The drawbacks of this flap are the loss of sensibility in the forearm (partially transient) and the scar on the arm, which can be rather unsightly in young ladies and when big flaps are harvested skin graft is needed.     

A new technique for one-stage total lower lip reconstruction: Achieving the perfect balance

BACKGROUND:

Reconstruction of extensive lower lip defects is difficult. The authors describe a new technique of one-stage total lower lip reconstruction, with the ultimate goal being achievement of the delicate balance between adequate mouth opening and competent mouth closure, with satisfactory aesthetic outcome.

METHODS:

The authors applied their new reconstructive technique in a patient with extensive lower lip defect following excision of squamous cell carcinoma. Bilateral inferiorly based nasolabial flaps were used for reconstruction of lower lip. For vermillion reconstruction, a bucket-handle mucomuscular flap from upper lip was designed primarily using the pars marginalis portion of orbicularis oris. Compared with previously described techniques, this procedure is unique with respect to the alignment of the nasolabial flaps in relation to one another. Furthermore, this technique of vermillion reconstruction is a one-stage procedure with minimal morbidity, enables preservation of the vascular pedicle and innervation and maintains the orientation of orbicularis oris, thus providing a competent oral sphincter. To the authors’ knowledge, this mucomuscular upper lip flap has not been described earlier and has definite advantages over the commonly used methods of vermillion reconstruction.

RESULTS:

The functional and aesthetic outcomes are satisfactory on follow-up, with normal lip movements and sensation, adequate mouth opening and oral competence, good colour and texture match with adjacent tissues, and excellent volume and quality of the vermillion. No subsequent corrective surgery is required.

CONCLUSIONS:

This technique is simple and achieves the main goals of total lower lip reconstruction in a single stage with minimal morbidity.     

小腿外侧逆行岛状复合皮瓣修复足跟缺损

自1987年6月至1992年6月,我们用由小腿外侧皮瓣、腓骨及其邻近肌肉共同组成的小腿外侧岛状复合皮瓣,以腓动、静脉为蒂逆行移转修复足跟缺损6例均获成功,较好地恢复了足的行走与负重功能。     

下睑部分全层缺损修复

1993年以来,共为4例下睑恶性肿瘤患者行扩大切除,术后下睑部分全层缺损的修复,采用鼻中隔粘膜软骨复合组织片及口腔粘膜游离移植的方法,以修复睑板睑结膜层,外层应用邻近带蒂旋转皮瓣覆盖,共同重建下睑。手术效果令人满意,成功的关键在于外层皮瓣的良好选择。     

小腿外侧逆行岛状复合皮瓣修复足跟缺损

自１９８７年６月至１９９２年６月，我们用由小腿外侧皮瓣、腓骨及其邻近肌肉共同组成的小腿外侧岛状复合皮瓣，以腓动、静脉为蒂逆行移转修复足跟缺损６例均获成功，较好地恢复了足的行走与负重功能。     

颞区皮下蒂皮瓣修复下睑外翻的临床效果观察

目的 探讨应用颞区皮下蒂皮瓣修复各种原因所致下睑外翻的手术方法 及临床效果.方法 自2007年以来,对于各种原因所致皮肤全层组织缺损的下睑外翻,以同侧颞部无毛发区为供区,应用外眦动脉分支血管网皮下蒂颞区横行皮瓣修复24例.病因包括:感染瘢痕8例,外伤6例,肿物切除10例,皮瓣面积最大5.5 cm×1.5 cm,最小4....