表浅肌肉腱膜皮瓣联合硬腭黏膜移植修复全层眼睑缺损

目的探讨利用眼周表浅肌肉腱膜系统（SMAS）皮瓣联合硬腭黏膜移植修复中、重度全层眼睑缺损的临床疗效。方法对26例（26只眼）大于或等于眼睑全长1／2的全层眼睑缺损患者,采用硬腭黏膜移植替代眼睑后层,即睑板和睑结膜层;利用眼周血供丰富的SMAS皮瓣修复眼睑前层,即皮肤肌肉层。其中5例采用眼轮匝肌蒂皮瓣,5例为颞浅动脉皮瓣,7例为眉上皮瓣,9例为上睑皮肤轮匝肌双蒂瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眼周的SMAS转位皮瓣,术毕行睑缘缝合3个月。结果全部患者随访6～36个月,平均11个月。转位皮瓣全部成活,硬腭黏膜植片成活好,无收缩,眼睑外观及功能改善较满意。结论眼周SMAS皮瓣联合硬腭黏膜移植可一次性修复缺损的眼睑全层,效果肯定。

Use of periocular superficial musculo-aponeurotic system flap and hard palate mucosal graft in reconstruction of full-thickness eyelid defects

OBJECTIVE: To investigate the outcome of combining grafting of periocular superficial musculo-aponeurotic system (SMAS) flaps and hard palate mucosa in the reconstruction of modest and severe full-thickness eyelid defects. METHODS: Hard palate mucosa was grafted to replace the posterior layers of the eyelid (the tarsus and the conjunctiva) while periocular SMAS flap, which is rich in blood supply, was utilized to reconstruct the anterior layers of the eyelid (the skin and muscular layer). Among the 26 eyes of 26 patients treated with full-thickness eyelid defects of half or more palpebral length, orbicularis muscular flaps were utilized in 5 cases, superficial temporal arterial flaps in 5 cases, supra-eyebrow flaps in 7 cases and upper eyelid skin-orbicularis bipedicled flaps in 9 cases. The operation began with the grafting of hard palate mucosa. Periocular SMAS flaps were then designed according to the location and scope of the defect of the anterior layers of the eyelids and transposition procedure ensued. After the grafting procedures, tarsorrhaphy was performed in all cases and the closure was maintained for 3 months. RESULTS: All patients were followed for 6 to 36 months, averaged 11 months. The flaps and hard palate mucosal grafts existed well in all cases. No shrinkage in hard palate mucosal grafts was observed and satisfactory aesthetic and functional results were achieved. CONCLUSIONS: Combining grafting of periocular SMAS flap and hard palate mucosa can repair full-thickness eyelid defects as a one-stage operation with definite and good outcome.