1050例混合型睑袋修复术的临床疗效探讨

Clinical effect on baggy eyelid plasty: a report of 1 050 consecutive cases

目的 探讨一种新的肌皮瓣法行睑袋修复术 ,以获得符合美学标准的手术效果。方法 术前采用“皮肤夹捏法”确定去皮量。术中按照预先设计先切除皮肤 ,然后采用“肌肉拉放法”去除多余的眼轮匝肌 ,再切除松垂的眶隔脂肪或释放眶隔脂肪充填眶下缘凹陷。结果 眼轮匝肌瓣法行睑袋修复术 90 0例 ,术后发生暂时性睑外翻 2例 ,暂时性复视 2例 ,其余效果均较满意。外院 15 0例并发症中 ,采用邻近皮瓣转移术、眼睑紧缩术、埋置皮肤软组织扩张器和颞浅筋膜悬吊等方法修复睑外翻 15例 ,清除血肿 2 8例 ,切除缝合修复瘢痕增生 1例。结论 采用术前确定去皮量的肌皮瓣法 ,行混合型睑袋修复术 ,可以明显降低并发症的发生率 。

Objective To investigate a myocutaneous flap method for eyelid baggy plasty conforming to the medical aesthetic requirements. Methods Before operation the amount of the lower eyelid skin excised should be determined. Asking the patient to look upward at supine position, the operator lifted properly the lower eyelid skin using fine forceps without teeth at the results of smooth superficialness at this region and slight ectropion. The incision lines were marked along the print pinched by forceps and the trace 2 to 3 mm below the ciliary margin. Intra-operatively severing soft issues to the inferior orbital fringe just on the sub-orbicularis level, the skin-muscle flap was made. Then the excessive muscle was removed in the light of the incision lines. The orbital fat teased out resected or filled up the concavity along the lower orbital edge. Results The tense and smooth appearance of lower eyelid was archived in 900 cases received in our hospital except 2 temporary ectropion cases and 2 temporary double vision cases. We repaired the 15 ectropions using adjacent skin flap, tarsal reduction, skin soft tissue expansion, or superficial temporary fascia sling suspension, eliminated 28 haematomaes and made the excision of scar and wound suture for a hypertrophic scar case in the 150 complications from other hospitals. The crow wrinkles were improved apparently. Conclusion The amount of skin excision determined pre-operatively, which not only successfully refrains interfering elements from blooding and swelling but also avoids giving rise to ectropion, is accurate than that performed during operation. Natural appearance after operation becomes better and lasting because of orbicularis raised which strengthens the anterior wall of orbital septum.