以睑缘动脉弓为蒂的眼睑推进瓣的临床应用

目的探讨眼睑瓣在修复眼睑全层缺损中的应用。方法以睑缘动脉弓为营养血管蒂，在眼睑全层缺损的两侧与缺损底部等高，水平向两侧设计眼睑矩形瓣；若缺损较大，外侧眼睑瓣设计线可绕过眼外眦角（距外眦角0．5cm）延伸到对侧眼睑（上或下眼睑，根据缺损是在下或上眼睑），全层切开后水平向中央缺损区推进，分层缝合修复缺损。结果20例患者应用本法修复，其中眼睑基底细胞癌4例，鳞癌2例，海绵状血管瘤3例，色素痣6例，外伤性缺损3例，先天性眼睑缺损2例。缺损最大水平宽度1．7cm，最小0．7cm。缺损位于上睑6例，下睑14例。所有眼睑瓣均全部成活，修复后的眼睑外形佳，睑缘平滑，睫毛生长正常。结论以睑缘动脉弓为营养血管的眼睑瓣修复眼睑全层缺损是用同类组织修复，手术一次完成，效果良好，且睑缘动脉弓恒定，眼睑瓣血供丰富，是眼睑全层缺损较理想的修复方法。

Clinic application of compound flap pedicled with arterial arch of palpebral margin

Objective To study the clinic application of compound flap pedicled with arterial arch of palpebral margin in repairing severe full defect of eyelid. Methods According to eyelid structure and the defect size, the two compound flaps were designed beside the defect based on the arterial arch of the palpebral margin. If the defective area was too large, the lateral compound flap may be extended to lower or upper eyelid 0.5 cm away from the outer canthus, then cut and propelled the two compound flaps to repair the full eyelid defect. Results 20 cases had been cured with this method since 1998. In this cases, 4 cases were basal cell carcinoma of eyelid, 2 cases were squamous carcinoma, 3 angiomas, 6 chromatophore nevuses, 3 traumatic defects, 2 congenital defects. The largest length of eyelid full defect was 1.7 cm and the smallest was 0.8 cm. 6 cases were upper eyelid defect and 14 cases were lower eyelid defect. All the compound flaps survived completely without any complications. All cases obtained satisfactory results functionally and esthetically. Conclusions Repairing full eyelid defect with the compound eyelid flap is the same kind tissue repairing, it can not only provide enough tissues to primary repair large full defect of the upper or lower eyelid to restore normal anatomical structure and appearance of the eyelid, but also is easy to be operated without severe secondary deformities. The arterial arch of the palpebral margin is constant and the blood supply of the compound flap is reliable. It is an ideal method of repairing the eyelid defect.