用易位睑板结膜瓣修复眼睑缺损

用易位睑板结膜瓣修复眼睑缺损郑州市第二人民医院眼科孙芳利用上睑或下睑缺损区以外残存的睑板睑结膜，设计成易位睑板结膜瓣１期修复全层部分睑缺损１０例１２只眼，取得了满意的效果。重建了眼睑功能。达到术后外形的美观。材料及方法一般材料１０例１２只眼，男８例，...     

滑行睑板结膜瓣用于下睑重建

眼睑恶性肿瘤均需采取手术切除的方法治疗。肿瘤切除后如何修复眼睑、恢复功能、改善美容,是困扰眼科医生的难题。我科自1999年1月~2004年3月共收治5例眼睑大范围恶性肿瘤,采用滑行睑板结膜瓣重建眼睑,取得较好疗效,现报告如下:1资料和方法1·1临床资料本组共5例(5眼)。其中男3     

深低温保存异体睑板睑结膜移植修复眼睑缺损的临床观察

目的 评价深低温保存异体睑板睑结膜移植修复,因眼睑肿物切除造成的眼睑缺损的临床效果.方法 采用深低温保存异体睑板睑结膜移植眼睑再造术修复眼睑缺损21例(21只眼).结果 术后随访3～80月,平均46.9月.本组病例共治愈10只眼,好转11只眼,1例(1只眼)因首次手术时切缘未净再次行扩大切除时未更换移植片导致植片脱落.结论 深低温保存异体睑板睑结膜移植修复眼睑缺损,简便易行,保存方便,术后并发症少,临床效果满意.异体睑板睑结膜是理想的眼睑缺损修复的材料.     

异体睑板移植修复眼睑缺损

目的 修复21眼因各种原因所致的部分或全层眼睑缺损。方法 采用低温保存的异体睑板移植替代瞪板,内层行结膜转移或唇粘膜移植。外层应用邻近带蒂皮瓣或游离显效5眼,改善2眼,失败1眼,术后效果与血运 的好坏和移植片的大小有关。结论 采用低温保存的异体睑板修复眼睑缺损,排斥反应轻,疗效佳。是替代睑板的理想材料。     

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。     

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。     

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     

自体睑板移植修复1/2眼睑缺损

自 2 0 0 1年 7月以来 ,我们以自体健眼睑板移植片一期修复肿瘤切除后的 1/2眼睑缺损 ,取得满意效果。现将我院的治疗结果和具体技术介绍如下。一般资料 :11例因眼睑肿块就诊的患者 ,男性 4例 ,女性 7例 ,年龄 42～ 78岁 ,平均 61岁 ;右眼 5例 ,左眼 6例 ,上睑 7例 ,下睑 4例。其中 ,8例患者已行肿块活检 ,病理证实为“睑板腺癌” ;其余 3例临床上呈现典型的睑板腺癌征象 ,即睑结膜面白色结节样隆起。全部病例肿瘤范围不大于6mm ,均未侵入穹隆部 ,耳前、颌下淋巴结未及肿大。方法 :①自体睑板的制备 :地卡因表面麻醉 ,利多卡因穹隆部浸润麻…     

肌皮瓣加游离睑板结膜瓣在下睑成形中的应用

我们于 1994～ 1999年间共收治 5例下睑肿瘤患者 ,肿瘤切除术后采用肌皮瓣加游离睑板结膜瓣一期行下睑成形术 ,取得较好效果 ,现总结如下。1　资料与方法1.1　临床资料　 5例中 ,男 2例 ,女 3例 ;年龄 35～ 78a。下睑缺损原因 :基底细胞癌 2例 ,鳞状上皮癌 2例 ,恶性黑色素痣 1例。下睑缺损范围 :占内侧 75 %者 2例 ,中央 75 %者 1例 ,中央 5 0 %者 1例 ,外侧 5 0 %者 1例。1.2　手术方法　确定病变范围 ,距病变边缘 5 mm全层切除病灶。取同侧上睑游离睑板结膜瓣作睑后层替代物 ,取缺损区周围肌皮瓣转移或推进覆盖睑后层替代物 ,本组中采用…     

多次Z字皮瓣在眼睑皮肤缺损的应用

目的探讨多次Z字皮瓣在较大眼睑皮肤缺损的应用效果,提出新的手术方式。方法眼睑皮肤缺损31例（38眼）使用多次Z字皮瓣进行修复。结果31例（38眼）眼睑皮肤缺损修复良好,未形成眼睑畸形,不影响眼睑的美容和功能。结论多次Z字皮瓣可以较好地修复眼睑皮肤缺损,保持眼睑功能及外观     

复合组织移行瓣在眼睑缺损整复中的应用

目的采用复合组织移行瓣做上、下睑再造手术,对上、下眼睑缺损进行修复,评价其在功能修复与外观美容等方面的作用。方法对10例眼睑缺损患者行复合组织移行瓣再造手术,在距上睑或下睑缘3～4mm处平行于睑缘全层切开,分离形成一皮瓣,分别上移行或下移行修复缺损处,如皮肤缺损较大,可再加游离植皮进行修复。术后随访时间为3~38个月,观察其修复形态和闭启程度。结果10例患者术后眼睑缺损部位均得到满意修复,皮瓣及皮片成活,色泽良好,活动自如。结论该手术可有效满足上或下睑部分全层缺损的修复,做到一期手术,一期愈合,达到功能与外观的完满结合。     

颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损

目的探讨颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损的适应证、安全性和有效性。方法根据颞浅血管的解剖分布,制备以颞浅动脉为蒂形成的顺行岛状皮瓣,通过皮下隧道移转至缺损区,修复各种原因所致的重度眼睑及眶周组织缺损患者18例（18眼）。术后随访6个月,观察皮瓣存活、眼睑功能恢复情况和手术效果。结果16例皮瓣完全存活,皮瓣颜色与受区皮肤相近,质地柔软,皮瓣感觉功能良好,睑裂闭合良好,外观满意。1例术后早期出现静脉回流障碍,经积极处理,皮瓣远端有小片表皮坏死。1例皮瓣因严重静脉淤滞坏死,术后3个月行游离植皮术,植皮存活。6例患者因皮瓣肿胀,行Ⅱ期修整术。结论颞浅动脉顺行岛状皮瓣具有血供丰富、色泽质地与受区相近等优点,是修复重度眼睑及眶周组织缺损并重建眼睑功能和外观理想的皮瓣。     

Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM: To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS: The clinical data of 23 patients (23 eyes) who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed. All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterior- or posterior-layer eyelid defects. The survival rate of the propeller flap, eyelid function and appearance, tumor recurrence rate, and patient satisfaction were evaluated after the surgery.RESULTS: The patients consisted of 12 men and 11 women, aged 31–82y (mean, 58.9y). The longest follow-up time was 5y, and the shortest was 3mo. All the propeller flaps survived well. There was no significant difference in color and luster between the flap and adjacent tissues, and there was no dog ear phenomenon. No obvious scarring was observed. There were no obvious abnormalities of eyelid morphology or function, and no adverse complications such as exposure keratitis, entropion, ectropion, ptosis, and eyelid retraction. No tumor recurrence was found at the time of the last follow-up. All patients were satisfied with the surgical results.CONCLUSION: The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactory outcomes in terms of eyelid function and esthetics, and merits clinical application.     

Modified second stage Hughes tarsoconjunctival reconstruction for lower eyelid defects

To describe a novel technique utilizing an amniotic membrane graft (AMT) to create the mucocutaneous portion of the lower eyelid margin in a modified Hughes eyelid reconstruction for secondary revision or prevention of a hyperemic, hypertrophic conjunctival margin with excessive discharge. This was a retrospective, non-comparative interventional study. Thirty consecutive patients who underwent a modified Hughes reconstruction were included. The first step of the reconstruction was performed in a standard fashion using a tarsoconjunctival flap from the ipsilateral upper eyelid. The second stage was accomplished by the division of the tarsoconjunctival flap. The modification of the procedure included the addition of AMT (Ambio 5®, IOP Ophthalmics, CA) to the new mucocutaneous junction. Main outcome measures included the post Mohs surgery defect size, post-reconstruction complications. One patient received AMT for a revision of a hyperemic lid margin following reconstruction, while 29 subsequent patients received AMT as a primary procedure. The mean size of the post-Mohs defect was 23.75 ± 6.6 mm² horizontally and 9.1 ± 5.4 mm² vertically, involving 79.53 ± 16.8% of the lower eyelid. There was no evidence of hyperemic or hypertrophic margin at a mean follow-up of 4.41 ± 2.91 months. The addition of an AMT for the revision, or as a primary procedure for prevention of a hyperemic, hypertrophic eyelid margin with excess mucus production in the post-Hughes lower eyelid reconstruction has favorable outcomes in this preliminary study, however warrants further investigation with larger number of patients and longer follow-up.     

转移皮瓣修复眼眶组织巨大缺损

目的:观察几种不同类型转移皮瓣修复眼眶组织巨大缺损的临床效果,探讨眼眶组织巨大缺损的修复技巧。方法:回顾性分析16例被恶性肿瘤广泛破坏眼睑、眶周皮肤、眶内球旁组织及眼球的患者。行控制性或扩大切除肿瘤后,利用眶周健康组织形成转移皮瓣进行修复缺损区,供皮处缺损区取上臂内侧或腹部全厚游离皮片修复。观察术后6mo皮瓣存活情况,分析与皮瓣存活有关的术式及皮瓣类型。结果:患者16例中接受控制性切除肿瘤的患者12例12眼,扩大切除肿瘤者4例4眼;缺损区采用额部或额顶部轴型皮瓣修复10例10眼,皮下蒂皮瓣4例4眼,反转皮瓣2例2眼;术后接受放射治疗12例12眼,未接受放射治疗4例4眼,随访至术后6mo,所有皮瓣均存活。结论:转移皮瓣是修复眼眶组织巨大缺损的安全、有效方法。     

异种脱细胞真皮基质联合邻位皮瓣修复眼睑全层缺损的临床观察

目的 观察异种脱细胞真皮基质联合邻位皮瓣Ⅰ期修复眼睑恶性肿瘤切除术后眼睑全层缺损的临床疗效.万法 35例(35眼)眼睑恶性肿瘤患者,其中基底细胞癌21例,睑板腺癌13例,鳞状细胞癌1例;累及上睑者12例,累及下睑者23例.所有患者均行术中冰冻并根据冰冻结果确定切缘,肿物切除后眼睑有不同程度全层缺损.取异种脱细胞真皮基质替代结膜睑板组织,根据皮肤缺损大小做邻近滑行或转位皮瓣修补眼睑缺损.术后观察皮瓣及口腔修复膜愈合情况、有无眼睑闭合不全及睑球粘连.结果 随诊半年,异种脱细胞真皮基质已完全溶解,被爬行结膜上皮覆盖,皮瓣愈合良好、无一例皮瓣坏死.其中28例患者术后恢复良好,无眼睑闭合不全及睑内、外翻.4例患者出现轻度眼睑闭合不全,均无暴露性角膜炎.3例患者出现轻度睑球粘连.结论 异种脱细胞真皮基质可替代睑板结膜组织,联合邻位皮瓣治疗眼睑恶性肿瘤切除术后的眼睑全层缺损有较好的临床疗效,可减少患者因取口唇黏膜或行二次眼睑重建的痛苦.     

Infra orbital bipedicled bridge flap in lower lid reconstruction

The infraorbital bipedicled skin-muscle-flap is a well vascularized flap, which provides a good blood supply for underlying free grafts. The main disadvantage when using this flap is the fact that the free skin graft, which is necessary for closure of the secondary defect, shows an unattractive appearance fora longer period of time. In my opinion the use of the bipedicled flap is indicated only in patients with total lower lid loss combined with defects at the inner and outer canthus. In cases of simple lower lid loss other well known procedures should be preferred.     

Laser-assisted tarsoconjunctival flap harvesting for lower eyelid defect reconstruction.

Tarsoconjunctival flap procedures are reliable and versatile procedures for reconstruction of large lower lid defects. We present a new carbon dioxide laser-assisted flap-harvesting technique. This technique combines precise and accurate incisions with simultaneous complete hemostasis. We have done carbon dioxide laser-assisted flap harvesting for large and total lower lid defects. The hemostatic evaporative cutting of the carbon dioxide laser decreases time, swelling, and bleeding in obtaining tarsoconjunctival grafts and flaps.