皮肤扩张术在眼睑组织修复中的应用(附21例报告)

目的探讨皮肤扩张术在眼睑组织缺损修复中的临床应用方法及效果。方法2004年4月-2009年4月对21例患者采用皮肤软组织扩张术修复眼睑软组织缺损,男9例,女12例,年龄6～48岁,平均29岁,病程6个月～23年,其中上睑软组织缺损12例,下睑软组织缺损9例。瘢痕侵犯眼睑的面积为5mm×20mm～30mm×50mm。10例因瘢痕挛缩致不同程度的睑外翻,眼睑闭合不全。一期手术选用30～100ml的扩张器埋置于睑部临近的正常区域皮下,注水扩张3～4个月,二期应用不同大小的扩张皮瓣修复眼睑缺损创面,恢复睑缘正常位置。结果术后患者伤口均I期甲级愈合,未见并发症。16例患者获随访,随访时间为1个月～1年,平均10个月。随访患者扩张皮瓣全部成活,眼睑瘢痕均得以改善,仅1例因注水时终止治疗致扩张量不足,半年后仍有轻度的睑外翻,余患者睑缘位置正常,眼睑闭合不全得到矫正,睑外翻无复发。结论皮肤软组织扩张术应用于眼睑软组织缺损的修复疗效肯定。

Application of tissue expansion in repair of eyelid defects; a report of 21 cases

Objective To explore the clinical technique and curative effect of tissue expansion in repairing soft tissue defects of eyelid. Methods Repair of eyelid defects with tissue expansion was performed in 21 patients (21 eyes) from Apr. 2004 to Apr. 2009, in whom there were 9 males and 12 females, aged 6-48 years (mean 29), in a course of 6 months to 23 years. Twelve defects were in upper eyelid and 9 in lower eyelid. The areas of eyelid scars ranged from 5mm×20mm to 30mm×50mm, and 10 patients were with ectropion of eyelid due to cicatrical contraction. Tissue expanders sized 30-100ml were implanted beneath the normal skin adjacent to lesions of eyelids, and normal saline solution was periodically injected for 3 to 4 months to slowly expand the overlying skin. Then the expanders were removed, and different sizes of adjacent expanded skin flaps were used with rotation to repair the eyelid defects and restore normal position of palpebral margins. Results Satisfactory wound healing was obtained in all the 21 patients with no complication. Sixteen patients were followed-up for 1 to 16 months (mean 10 months), in them the expanded flap survived nicely with acceptable cosmetic result, and the postoperative scar was not conspicuous. No recurrence of ectropion occurred except one with mild ectropion due to termination of expanding treatment by the patient Conclusion Tissue expansion technique is a reconstructive option for eyelid defects.