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.     

睑板腺癌术后眼睑缺损的整复

目的探讨睑板腺癌术后眼睑缺损的整复方法。方法睑板腺癌6例。1例上睑肿物切除后上睑缺损小于1/4,创缘直接分层缝合;1例上睑肿物切除后上睑缺损大于1/2,但未侵及睑板上缘,残留睑板结膜瓣向下滑行修复缺损;2例肿物侵及睑板上缘,切除后缺损分别大于1/2和3/4,下睑板结膜滑行修复上睑缘,上睑提肌瓣向下滑行和滑行睑板吻合;1例下睑肿物切除后缺损大于3/4,鼻颊部皮瓣转移修复;1例部分眶内容摘除植皮修复。结果术后随访观察12～19个月,1例眶内容摘除眶内皮片成活良好,其余5例眼睑外形及功能均恢复,眼睑闭合好,活动自如。结论睑板腺癌切除术后根据眼睑缺损的部位和大小选择不同的修复方案,均取得了良好的效果。     

用外侧眶骨膜瓣代替睑板行眼睑重建术

目的 评价用外侧眶骨膜瓣代替睑板行外侧眼睑重建术的手术效果.方法 回顾性分析13例外眦部眼睑肿瘤切除术后患者的临床资料,其中眼睑基底细胞癌7例,睑板腺癌4例,鳞状细胞癌2例,切除肿瘤同时一期用外侧眶骨膜代替睑板,用颧部或颊部的旋转皮瓣或滑行皮瓣修复缺损皮肤行眼睑重建术.结果 术后随访8～56个月,未发现肿瘤复发,所有患者眼睑形态自然,双侧睑裂基本对称,眼睑活动好,无眼睑切迹及内翻倒睫和外翻情况出现.患者对手术疗效表示满意.结论 用外侧眶骨膜瓣代替睑板行眼睑重建术对于外侧眼睑缺损在1/3-2/3范围内且肿瘤未影响到眶骨的患者,尤其对于同时影响上下睑的患者的眼睑修复是一种较好的方法 .(中华眼科杂志,2009,45:127-130)     

对位睑板结膜瓣滑行修复眼睑缺损

目的：评价对位睑板结膜瓣滑行修复眼瞪缺损的效果。方法：对41例眼瞪全层缺损患者,其中上睑10例,下睑31例,切除肿瘤导致缺损者33例。外伤导致缺损者8例,缺损范围在1/3-2/3,年龄24-79岁,采用与缺损眼睑相对应的眼睑睑板结膜瓣滑行至缺损区来修补眼睑缺损。结果：术后随访31例,随访时间3月-5年,除缺损外,1例出现轻度上睑退缩（退缩量为1-2mm),1例出现轻度下睑外翻,余眼睑外形及功能均基本恢复,眼睑活动自如,闭合完全,无严重并发症发生,结论：对位睑板结膜瓣滑行可用于修复眼睑后层缺损,且不受有无睑板替代物的限制。不需另添手术创口,可更好地恢复眼睑的功能及外观。     

自体眶骨膜替代睑板植入修复外眦部眼睑缺损

目的观察自体眶骨膜修复眼外眦部眼睑缺损的临床效果。方法采用自体眶骨膜替代睑板联合滑行结膜瓣和眶周旋转滑行皮瓣修复外眦部眼睑缺损。共6例（6只眼）,术后随访6个月至3年。结果术后眼睑形态及功能满意,无收缩性上睑内卷,睑内外翻,植入骨膜瓣无吸收、移位及感染。结论自体眶骨膜替代睑板植入修复外眦部眼睑缺损简便易行,术后并发症少。自体眶骨膜是理想的睑板替代物。     

异体巩膜联合自体结膜滑行瓣修复眼睑缺损

目的探讨异体巩膜联合自体结膜滑行瓣修复眼睑全层缺损的ll缶床效果。方法对10例因肿瘤切除术或外伤后造成的眼睑全层缺损范围等于或大于1／3眼睑的患者行异体巩膜移植联合自体结膜滑行瓣修复眼睑后层缺损,并随访观察半年至2年。结果全部病例经眼睑重建术后,异体巩膜无溶解或排斥现象,植片生长良好,无巩膜暴露,眼睑形态基本正常,对眼球无刺激,对视功能无影响,肿瘤未见复发。结论对于因肿瘤切除术或外伤造成的眼睑全层缺损,异体巩膜联合自体结膜滑行瓣术式是一种有效的手术方式。     

异体巩膜移植治疗眼睑恶性肿瘤术后睑板缺损的临床观察

目的：探讨异体巩膜移植在眼睑恶性肿瘤切除术后睑板缺损重建手术中的临床效果。

方法：对24例24眼眼睑恶性肿瘤术后睑板缺损长度大于1/2睑板的患者实施眼睑重建, 利用异体巩膜替代睑板,异体巩膜材料取自眼库。

结果：术后3～12mo随访,眼睑重建术后形态良好,未出现明显的异体巩膜溶解或排斥反应; 巩膜脉络膜面均被结膜细胞移行覆盖,异体巩膜与皮肤粘连紧密,缺损区修复完整。4眼出现睑缘轻、中度内翻后行眼睑内翻矫正。2眼出现不同程度睑球粘连,行睑球粘连分离手术。

结论：异体巩膜具有材质稳定性好、组织相容性佳、取材保存方便、手术操作简单易行等优点。术后眼睑功能良好、外观满意,是理想的睑板替代材料。     

保存异体睑板修复睑板缺损的临床观察

目的观察眼睑肿瘤术后保存异体睑板Ⅰ期修复睑板缺损的疗效。方法采用纯甘油保存的异体睑板,对58例眼睑肿瘤切除术后的患者行Ⅰ期睑板缺损修补术,用转位或滑行肌皮瓣和结膜瓣铺衬于异体睑板两侧。分析异体睑板的血运环境、异体睑板大小、保存时间与手术疗效的关系。术后随访3个月至10.5年,平均1.8年。结果58例中,43例异体睑板结膜瓣遮盖完全,术后1周异体睑板内可见新生血管,1个月后新生血管布满整个植片;15例异体睑板结膜瓣遮盖不全,术后2～3个月新生血管长满植片,而裸露部位的植片表层可见不同程度的融解。不同大小结膜瓣间的植片愈合效果比较,差异有显著性（χ     

眼睑恶性肿瘤切除术后异体巩膜移植的眼睑再造

目的：探讨眼睑恶性肿瘤切除术后异体巩膜移植的眼睑再造手术效果。方法：采用保存的异体巩膜代替睑板，对28例眼睑恶性肿瘤切除术后进行眼睑再造术，6例皮肤除较大，行皮瓣转位及游离植皮，4例外眦韧带切除者，将巩膜移植片外侧延长固定于眶骨缘以代替外眦韧带，术后随访3－72月，平均37．5月。结果：28例术后均未见排异反应，眼睑外观满意；运动自如，闭合良好，结论：较大的眼睑恶性肿瘤切除的患者采用异体巩膜移植眼睑再造术，能达到保持眼睑功能和美容的效果。     

带蒂肌皮瓣加游离睑板结膜瓣重建眼睑

目的 总结用带蒂肌皮瓣加游离睑板结瓣一期修复眼睑全导的缺损的手术。方法 取同侧或对侧游离睑板结膜瓣作睑后层替代物，同侧睑周带蒂肌眼瓣复盖睑后层替代物重建眼睑。结果 本组６例均获得满意的功能重建和可接受的外貌。结论 带蒂肌上瓣加游离睑板结膜瓣是修复眼睑全层缺损的较好方法。     

Transplantation of Eyebank Sclera in the Cutler — Beard Method of Upper Eyelid Reconstruction

A modification of the Cutler-Beard, or bridge flap, technique for upper eyelid reconstruction using donor sclera for tarsal replacement was performed in 26 patients with follow-up ranging from eight months to nine years. Because the flap advanced from the lower lid normally contains little or no tarsus, donor sclera is inserted between the conjunctiva-lower lid retractor and the skin-muscle layers and is fixed medially and laterally to the tarsal remnants and to the levator aponeurosis superiorly in order to provide substance and stability to the upper lid. Use of donor sclera for tarsal replacement has provided a more normal appearance and greater stability to the reconstructed upper lid. No infection, shrinkage, or rejection has occurred.     

Double composite lid reconstruction: a new method of upper and lower lid reconstruction

The double composite grafting technique utilizes two composite lid grafts from an opposing upper and lower lid for reconstruction of extensive lid defects. These two composite grafts are covered by a rotational pedicle advancement skin flap. The skin defect created by such an advancement graft is covered by a free skin graft. The donor areas are closed directly by a layer-by-layer approximation. This new single-stage technique allows reconstruction of large lid defects without covering an affected eye for a prolonged period and without jeopardizing the irreplaceable entity of a "normal" lid margin.     

CONGENITAL UPPER lid COLOBOMA

Twenty-two patients with congenital upper lid colobomas were assessed Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media A traction test is strongly recommended early in all children with congenital upper lid colobomas A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.     

Congenital upper lid coloboma

Twenty-two patients with congenital upper lid colobomas were assessed. Strabismus occurred in 13 cases and was associated with bands of fibrous tissue or adhesions, high refractive errors and opacities in the ocular media. A traction test is strongly recommended early in all children with congenital upper lid colobomas. A lateral cantholysis and direct closure was the commonest type of surgery, but unless the coloboma closed easily a lower lid rotation flap gave the best results.     

Eyelid reconstruction with tarsomarginal grafts

Summary In the past 3 years, 85 basal cell carcinomas were treated in our clinic using eyelid reconstruction. During the same period, 54 lids were reconstructed after other diseases, mostly after chemical burns. In one of the 54 patients, the upper lid was reconstructed using a tarso-marginal graft after congenital coloboma. Method: In 31 of the 85 patients with basal-well carcinoma (36 %), so much tarsus was lost that a transplantation of tarsus was necessary. Fifteen of the 31 patients were treated with a Hughes-plasty and 16 using a tarsomarginal graft, two in the upper lid. Results: In eight of the remaining 16 cases, the defect was less than one half of length, so that the graft was taken from the second lower lid. In the remaining eight patients, the defect was two thirds of length or longer. In six cases, a 7 mm-graft was taken from the upper lid. As the tarsus from the upper lid measures 10 mm and is thus twice as big as the lower lid tarsus, it was divided into two grafts, resulting in two grafts measuring 7 × 5 mm. They were placed in the lower lid (“double tarsomarginal graft”). The former lower part with lashes was placed in the middle of the lower lid, the former upper part peripherally. In two patients, the defect was healed with three tarsomarginal grafts. A pedicle skin flap was transposed to cover the posterior grafts. Remaining defects were closed with free skin transplants. Conclusion: The tarsomarginal graft permits a short operation time and early rehabilitation of the patients. The disadvantage of the double tarsomarginal graft is that the more valuable upper lid tarsus is used to reconstruct the less valuable lower lid tarsus.      

旋转易位皮瓣及颧颌皮瓣在下睑缺损整复中的应用研究

目的：探讨外伤及肿瘤切除等原因造成的下睑(前层及全层)缺损的Ⅰ期整复及再造方法在功能修复与外观美容等方面的作用。方法：对61例因外伤及下睑良、恶性肿瘤切除所致的下睑前层缺损或下睑全层缺损的患者分别选择旋转易位皮瓣或颧颌皮瓣修复缺损，观察近远期疗效及并发症。结果：术后皮瓣全部成活，色泽良好，活动度满意。结论：上述两种方法对于下睑缺损(不论缺损大小，深浅程度如何)均可完满修复，达到功能与外形的完美结合。     

Surgical correction for lower lid epiblepharon in Asians

BACKGROUND/AIMS: Epiblepharon is a congenital lid anomaly in which a fold of skin and underlying orbicularis muscle push the lashes against the eyeball. It is important to get a good lash eversion effect without forming a prominent lid crease in Asian patients. The surgical effect of this rotating suture technique was evaluated. METHODS: Surgical correction for epiblepharon was performed on 197 patients and the results analysed in 169 patients who had been followed for 1 month or more. After subciliary incision, several buried 8-0 nylon sutures were placed to allow adhesion between the tarsal plate and the subcutaneous tissue of the upper skin flap with minimal resection of pretarsal orbicularis and redundant skin. RESULTS: 156 patients (92.3%) showed satisfactory results during 7.1 months of average follow up. Reoperation was performed only on two patients out of 13 because of mildness of symptoms and signs. Complications were minimal including suture abscesses in four patients and wound dehiscence in one. CONCLUSION: The rotating suture technique was very effective in repairing epiblepharon without forming a prominent lower eyelid crease.     

眼部烧伤眼睑全层缺损修复术成功的影响因素

目的探讨影响游离皮瓣联合异体巩膜、羊膜移植修复眼睑缺损成功的因素。方法选择2000年2月-2007年10月西安市眼科医院收治的41例（41眼）的眼烧伤眼睑全层缺损者。其中热烧伤15例,碱烧伤20例,酸烧伤6例。烧伤后3～24个月,行大腿内侧游离皮瓣联合同种异体巩膜及羊膜移植术。其中5例联合行睑球粘连分离及板层角膜移植术。术后随访6—36个月。结果眼睑再造术41例中有35例眼睑重建成功,移植片成活,其中5例在6～12个月出现瘢痕收缩,使眼睑部分闭合不全。6例术后2周出现皮瓣愈合不良、脱落、溶解。结论自体游离皮瓣联合同种异体巩膜、羊膜移植修复眼烧伤所致的眼睑全层缺损,是临床治疗烧伤眼睑缺损的有效方法。手术时机的选择、烧伤程度的评估、手术方法的改善是决定手术成功的重要因素。