扩张皮瓣修复眶周软组织缺损睑外翻的预防方法

目的探讨应用扩张皮瓣修复眶周软组织缺损时预防睑外翻的方法及效果。方法 2015年4月至2019年12月,中国医学科学院整形外科医院收治176例眶周软组织病损患者,男79例,女97例,年龄4~53岁,病损范围1 cm×1 cm~6 cm×10 cm。术前根据病损的部位及大小选择合适的扩张器;一期埋置扩张器,按期注水扩张;二期将扩张皮瓣转移覆盖眶周缺损创面,切除部分包膜,并将皮瓣固定于骨膜,恢复眼睑位置与形态,预防睑外翻;术后佩戴弹力头套3~6个月进行塑形。术后对皮瓣成活情况及并发症进行随访。结果 176例患者埋置的扩张器容积为30~400 ml, 扩张时间1~6个月,所获扩张皮瓣大小为3 cm×3 cm~6 cm×9 cm。术后随访2个月至4年,皮瓣全部成活。其中出现睑裂轻度闭合不全13例,为皮肤扩张不充分所致,未影响眼睑功能,患者拒绝再次治疗;下睑外翻8例,包括术后瘢痕挛缩5例,固定皮瓣的线结脱落1例,扩张器长期牵拉使下睑支撑组织松弛2例,其中5例行皮瓣修整术后矫正,3例未再次治疗;其余均获得满意效果。缝线固定皮瓣所留凹陷在术后1~6个月内消失。结论以扩张皮瓣修复眶周软组织缺损时,在术前、术中及术后分别实施针对性的干预措施,以减小或分散扩张皮瓣的回缩力,可最大程度地避免睑外翻发生,获得良好的修复效果。

Prevention of ectropion when using expanded skin flap to repair periorbital soft tissue defect

Objective To explore the method and effect of preventing eyelid ectropion when using expanded skin flap to repair periorbital soft tissue defect.Methods From April 2015 to December 2019,176 patients with periorbital soft-tissue defect were treated in the Plastic Surgery Hospital of Chinese Academy of Medical Sciences,including 79 males and 97 females,aged 4-53 years,the defect ranging from 1 cm×1 cm-6 cm×10 cm.According to the location and size of the defect,an appropriate expander was selected before the operation.In the first stage,the expander was embedded,and saline was injected regularly.In the second stage,the expanded flap was transferred to cover the periorbital defect wound,part of the capsule was removed,and the flap was fixed on the periosteum to restore the position and shape of the eyelid and prevent eyelid ectropion.After the operation,elastic headgear was worn for 3-6 months for shaping.The survival and complications of the flaps were followed up.Results The expander volume was 30-400 ml,and the expansion time was 1-6 months.The size of the expanded flap was 3 cm×3 cm-6 cm×9 cm.All flaps survived after 2 months to 4 years follow-up.Among them,13 cases had mild lagophthalmus,which was caused by insufficient skin expansion and did not affect the eyelid function,so the patients refused to retreat;8 cases of lower eyelid ectropion,including 5 cases of scar contracture,1 case of suture knot falling off,and 2 cases of lower eyelid support tissue relaxation caused by long-term stretching of expander,5 cases were corrected after skin flap repair,3 cases were not treated again;the rest were satisfactory.The depression left by the suture fixing flap disappears within 1 to 6 months after surgery.Conclusions When using an expanded skin flap to repair periorbital soft-tissue defect,preoperative,intraoperative and postoperative interventions were implemented to reduce or disperse the retracting force of expanded skin flap,which could avoid eyelid ectropion and achieve good repair effect.