硬腭黏膜游离移植在全层眼睑缺损修复中的应用

目的 探讨硬腭黏膜游离移植在修复中、重度全层眼睑缺损中的应用效果.方法 首先根据睑板的缺损范围切取硬腭黏膜,行游离移植修复眼睑后层(睑板结膜层),再依据眼睑软组织的缺损部位和范围设计皮瓣,并转移皮瓣修复.结果 本组共198例患者(198只眼).其中上睑58例,下睑131例,上下睑联合缺损9例;硬腭移植面积最小10 mm×5 mm,最大35 mm×20 mm.术后随访3～24个月,硬腭黏膜均成活良好,无明显回缩,眼球未见损伤,眼睑外观及功能改善满意.1例眼轮匝肌蒂皮瓣远端2/3坏死,术后2周采用局部皮瓣修复,1个月后随访发现硬腭黏膜完全成活.结论 对中、重度全层眼睑缺损的衬里修复采用硬腭黏膜游离移植,手术操作简便,易成活,远期效果肯定.     

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。     

鼻部皮肤小肿瘤切除后的缺损修复

目的 回顾和总结鼻部小面积皮肤肿瘤切除后,创面的修复原则和术式选择.方法 选择直径≤2.0 cm,鼻下部1/3皮肤良恶性肿瘤切除后致鼻部组织缺损的73例患者.根据缺损部位、范围、类型和患者的要求,应用局部双叶皮瓣修复鼻尖、鼻翼和鼻侧壁皮肤软组织缺损(n=31);鼻唇沟皮瓣修复鼻翼外侧全层缺损(n=8);鼻唇沟皮下蒂皮瓣修复鼻翼皮肤软组织缺损(n=12);耳郭复合组织瓣游离移植修复鼻翼缘全层缺损(n=22).结果 71例患者手术获得完全成功,对修复术后效果满意.1例鼻唇沟皮瓣远端折叠部分皮肤浅层坏死,换药后愈合,鼻翼、鼻孔轻度变形.1例耳郭复合组织瓣游离移植再造鼻翼术后因感染而失败.结论 应用局部双叶皮瓣、鼻唇沟皮瓣、皮下蒂皮瓣或耳郭复合组织游离移植修复鼻部直径≤2.0 cm的皮肤肿瘤切除后的创面,可获得Ⅰ期修复的满意效果.     

联合应用皮瓣移植与扩张皮瓣修复唇颊部全层组织缺损

目的：探讨唇部全层复合组织缺损的修复治疗方法。方法：根据缺损的部位、层次、大小等，分别采用下颌部面动脉逆行岛状皮瓣，胸锁乳突肌皮瓣，颞浅动脉额支岛状皮瓣，耳后岛状皮瓣瓦合以扩张皮瓣进行修复。结果：17例唇颊部全层缺损患者分别应用皮瓣移植加扩张皮瓣转移修复治疗，所有皮瓣全部成活，外形及功能满意，经半年至5年随访未见并发症发生，效果良好。结论：唇颊部复合组织缺损手术方法要依病情合理选择，小的缺损可以应用局部组织瓣转移修复，本方法适用于局部组织瓣转移难以修复的较大唇颊部全层组织缺损，修复后唇颊丰满度适中，皮肤色泽纹理接近正常，形态满意。     

三例烧伤后眼睑全层缺损修复的经验

我科42年来治疗3例烧伤后眼睑全层缺损伴颜面深烧伤的病人。其中2例3处上睑中段全层缺损,1例两眼上下睑全长全层缺损。3例均取得较好的修复效果。例1 男,30岁,特重烧伤,伤后12天出现左上睑中段全层缺损8mm×6mm,因额颞顶颊大片Ⅲ度烧伤无法做皮瓣,上睑缺损局部植皮修复3次均因在翻身床上俯卧压迫而感染失败,出现暴露性角膜炎、溃疡、小白斑。一年后沿上下睑外翻、缺损边缘切开,剥离结膜囊,封闭睑裂,移转右食指背带蒂皮瓣覆盖睑区创面。3个月后切开睑裂,视力0.2。16个月后补充全厚植     

眼轮匝肌蒂皮瓣修复眼睑分裂痣切除后皮肤缺损

目的：采用眼轮匝肌蒂皮瓣Ⅰ期修复眼睑分裂痣切除后的皮肤缺损。方法：切除上、下睑病变区皮肤,上睑缺损可行全厚皮片移植或局部A-T皮瓣修复。下睑根据皮肤缺损面积于缺损缘左右两侧各设计眼轮匝肌蒂皮瓣,酌情游离,向中间推进拼合,按睑袋术式缝合睑缘皮肤,Ⅰ期修复上、下睑皮肤缺损。结果：共治疗13例,皮瓣最大面积2cm×1.5cm,均Ⅰ期愈合,形态满意。结论：下睑双侧眼轮匝肌蒂皮瓣可Ⅰ期修复中度大小的眼睑分裂痣,方法简单,疗效满意。     

硬腭黏膜联合鼻唇沟皮瓣修复大面积下睑全层缺损

目的:探讨应用硬腭黏膜联合鼻唇沟皮瓣修复大面积下睑全层缺损的手术方法及疗效。方法:2014年9月-2016年4月收治下睑全层缺损患者10例,均采用硬腭黏膜联合带穿支血管的鼻唇沟皮瓣修复下睑全层缺损。结果:10例患者皮瓣及硬腭黏膜全部成活,术后24h内有2例患者皮瓣远端出现静脉回流障碍,给予促血液循环等对症治疗后缓解。8例患者随访6～24个月,平均13个月。皮瓣质地柔软、色泽正常。供区瘢痕不明显,患者均无眼部不适症状,对手术效果满意。结论:硬腭黏膜联合鼻唇沟皮瓣具有血供丰富、成活率高,术后无明显瘢痕及眼睑继发畸形,皮瓣色泽与周围皮肤一致,效果满意等优点,是一种修复下睑全层缺损的较好方法。     

应用颞浅动脉额支反流轴型皮瓣修复上睑缺损

目的探讨应用跨血管区反流轴型额颞部皮瓣修复上睑软组织缺损的方法及效果。方法根据上睑软组织缺损的大小和位置设计跨血管区反流额颞部皮瓣,最大为3.5 cm×12.0 cm,其皮瓣长度应大于皮瓣蒂部至缺损区最远端1.5 cm;对累及睑板的缺损采用游离硬腭黏膜修复,再行皮瓣修复同侧上睑软组织缺损。结果本组共11例患者,均行跨血管区反流额颢部皮瓣修复,术后皮瓣完全成活,供区均直接缝合;随访6~12个月,无上睑缺损及外翻发生,效果满意。结论采用颞浅动脉额支为蒂的跨血管区反流轴型皮瓣修复上睑软组织缺损,方法可行,效果良好。     

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。     

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.     

Ear helix flap for reconstruction of total loss of the upper eyelid.

We present a patient with a recurrent carcinoma of the right upper eyelid who underwent resection of the subtotal upper eyelid resulting in a full-thickness defect. The eyelid was reconstructed with advanced conjunctival lining and an ascending helix chondrocutaneous flap from the right auricle. This flap was nourished with a reverse flow of the frontal branch of the superficial temporal vessels. A superficial temporal vein of the flap was anastomosed to the zygomaticofacial branch of the superficial temporal vein at the lateral canthal region to ensure adequate drainage. The flap survived without any congestion. An ascending helix flap is the best candidate for total loss of the upper eyelid.     

Bipedicle Orbicularis Oculi Flap in the Reconstruction of the Lower Eyelid Ectropion

Background Lower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid. Methods This study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion. In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect. Results No problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period. The incision scars were almost invisible. Conclusions The application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion is effective and reduces postoperative morbidity.     

Upper eyelid defect by dog bite reconstructed by an ipsilateral advanced tarsoconjunctival flap with skin graft

A technique for reconstruction of a traumatic upper-eyelid marginal defect utilizing a local tarsoconjunctival advancement flap with a skin graft is presented. A 22-year-old woman was bitten by a dog, resulting in a full-thickness loss of approximately the central half of her left upper eyelid. Debridement was performed under topical anaesthesia followed by one-stage upper eyelid reconstruction. The residual tarsal plate was used as a tarsoconjunctival advancement flap to reconstruct the posterior lamella of the defect. Skin from the posterior aspect of the left ear was grafted onto the reconstructed posterior lamella with two setting tarsorrhaphy sutures. One month postoperatively, the patient had an excellent cosmetic result with appropriate upper eyelid height and curvature, although cilia were not transplanted. The technique described offers a one-stage procedure with a simple surgical method providing on appropriate cosmetic and functional result.     

应用扩张预制黏膜衬里皮瓣修复眼睑缺损

目的 探讨眼睑全层缺损修复的新方法。方法 在额部扩张皮瓣的内面移植口腔黏膜，待黏膜成活后与皮瓣一起转移至眼睑部，分层缝合。4个月后行上、下睑裂分开，安装义眼。结果 修复后的外形较好，恢复了部分功能。结论 在扩张后的皮瓣内预制黏膜衬里皮瓣是修复眼睑全层缺损的一种较好的可行方法。     

Reconstruction of the levator function and conjunctiva using an inferiorly based orbital septal flap for subtotal full-thickness defects of the upper eyelid: two cases of ocular sebaceous carcinoma

Without using the lower eyelid, functional reconstruction of the tarsoconjunctival layer is challenging for subtotal full-thickness defects of the upper eyelid. In 2 cases of ocular sebaceous carcinoma, the levator function and conjunctiva were reconstructed using the inferiorly based orbital septal flap and conchal cartilage graft. The raw surface of the orbital septal flap was epithelialized within 14 days postoperatively. The new upper eyelid with a stable lid margin could open and close properly. Our surgical procedures may be available in the case that the lower eyelid is not usable.     

Use of the subcutaneously based nasolabial flap in lower eyelid reconstruction.

A 54-year-old male had a history of approximately 18 months, with a diagnostically proven squamous cell carcinoma of the lower left eyelid. The full-thickness subtotal defect was reconstructed with the Hughes procedure (tarsoconjunctival flap) combined with a subcutaneously based nasolabial flap for skin coverage. To our knowledge, the use of the subcutaneous based nasolabial flap in this context has not been described previously. Use of the nasolabial flap may be considered for eyelid reconstruction.     

A combined flap reconstruction for full-thickness defects of the medial canthal region.

The medial canthus is an aesthetically and functionally important area. Adequate consideration of the local anatomy is essential when reconstructing this area. We developed a combined flap technique with a simple combination of standard flaps for the treatment of extensive defects of the nose and upper and lower eyelids, including full-thickness medial canthus defect. In our technique, a median forehead island flap is used for the nasal region, the anterior surface of the eyelid is reconstructed along aesthetic unit, and the posterior surface is reconstructed with a palatal mucoperiosteal graft. A cheek flap is then used for the reconstruction of the lower eyelid. When reconstructing a small defect of the upper eyelid, the upper eyelid is advanced, while a V-Y advancement flap within the upper eyelid is used for a large defect. To reconstruct the acute angle of the medial canthus, a 0.3 mm titanium wire was passed through the tip of the tarsal plate of the upper and lower eyelids to be reconstructed and was fixed in the perforated nasal bone on the affected side. Using this technique, the acute angle of the medial canthus is well preserved after surgery, and is located symmetrically with its counterpart on the intact side. Our technique provides good reconstructive results and should serve as a valid alternative for the reconstruction of this area.     

Lower eyelid reconstruction in a paediatric face: a one-stage aesthetic approach using the versatile temporoparietal fascia flap

There are many different lower eyelid reconstruction techniques defined in the literature. Almost all of the published techniques have been described on elderly patients and use upper eyelid, periorbital or facial tissues as donor sites. However, in case of a paediatric patient or a young adult who has a crease-free and scarless face, camouflage of the facial donor-site scar is usually impossible. In order to avoid possible facial donor-site scars and upper eyelid deformities, a technique which uses the temporoparietal fascia (TPF) flap as the framework of a new eyelid was used for the reconstruction of an adolescent patient's postoncologic defect. The inner side of the flap was covered with nasal septal chondromucosal graft and the external side was covered with a retroauricular full-thickness skin graft. Eighteen months of unproblematic follow-up of this overlooked usage of the versatile TPF flap indicates that our technique has proved successful in terms of good functional and cosmetic outcome that is obtained at one stage.     

A Novel Way for Upper Eyelid Rejuvenation by Combination of Local Fat-Fascia-Muscle Flap Repositioning for Middle-Aged Asian Women

BackgroundUpper eyelid aging is common among middle-aged Asians. Apart from skin aging, there has been an increasing recognition for the role of sunken eyelid playing in upper eyelid aging. Various methods have been developed to deal with the upper eyelid volume deflation. However, autologous fat tissue could not achieve stable and satisfying rejuvenation results, especially for middle-aged patients who have established extremely low adipose tissue survival rates. Therefore, efficient rejuvenation methods with consistent long-term improvement are needed, especially for middle-aged patients.MethodsA retrospective study was conducted of 248 middle-aged patients who underwent the upper eyelid tightening and local fat-fascia-muscle flap reposition for upper eyelid rejuvenation in our department between 2015 and 2017. A precise sunken upper eyelid calculation method was used to evaluate the patients’ upper eyelid sunken volume prior to the operation for the guidance of sunken correction. The same method was also used to calculate the post-operation upper eyelid sunken volume to evaluate the operation efficiency.ResultsThe average age of the patients who underwent the surgery was 49.5±7 years-old. The fat-fascia-muscle flap was repositioned according to each patient's pre-operation sunken upper eyelid evaluation result, and precise and satisfying immediate sunken correction was observed after the surgery. Long-term consistent improvement was achieved. Compared to the pre-operation evaluation, the upper eyelid sunken correction ratio was nearly 90% in one year's follow-up, and no major complication occurred.ConclusionsThe fat-fascia-muscle flap reposition combined with sunken upper eyelid calculation has been proved efficient and consistent for middle-aged Asians upper eyelid rejuvenation.     

颞浅动脉岛状皮瓣联合软骨游离移植修复下睑全层缺损

目的:探讨应用颞浅动脉岛状皮瓣联合软骨游离移植的方法在修复下睑全层缺损中的效果。方法:对6例下眼睑全层缺损的患者,采用颞浅动脉岛状皮瓣联合软骨游离移植的方法进行修复,观察其效果。结果:皮瓣全部成活,颜色、质地与周围皮肤相近,术后均无下睑外翻。无明显瘢痕遗留,无软骨外露。无患者诉眼部不适。额部皮瓣供区无明显瘢痕增生。结论:在下眼睑全层缺损的修复中使用颞浅动脉岛状皮瓣联合软骨游离移植,对于功能和外形都有良好的改善作用,是值得推荐的方法。