“风筝”皮瓣在眼睑前层缺损修复中的应用

Using kite flap to repair the anterior lamellar skin defects of eyelid

目的探讨'风筝'皮瓣(亦称皮下蒂推进皮瓣)在修复眼睑前层(包括皮肤和眼轮匝肌)缺损的应用.方法于缺损邻接部位沿皮纹方向设计'风筝'皮瓣,按设计线切开皮肤,在眼轮匝肌下剥离形成以眼轮匝肌为皮下蒂的'风筝'皮瓣,推进转移修复皮肤缺损,用7-0无损伤缝线缝合.自1994年以来已用于14例,年龄15～64岁,缺损最大直径为上睑长度的1/3.结果皮瓣全部成活,切口Ⅰ期愈合,随访时间3个月至1年,眼睑形态满意,切口瘢痕不明显.结论对于眼睑前层范围较大不宜直接缝合,但尚有条件用局部皮瓣修复的中等大的缺损,用'风筝'皮瓣进行修复简单易行,效果可靠.其优点是,皮瓣通过推进转移的方式覆盖创面,没有旋转和变形,转移后局部平整,无'猫耳'等畸形产生,皮瓣蒂部宽广,血运良好,愈合后肤色与四周一致.

Objective To evaluate the use of the kite flap (als o known as subcutaneous pedicled V-Y advancement flap)for the repair of moderate -sized anterior lamellar skin defects of eyelid. Methods Since 1994, kite flaps have been used to repair anterior lamellar skin defects of eyelids in 14 patients. Six patients were male and eight female, with a mean age of 43 years (range 15-64 years). The diameter of the largest defect reache d 1/3 length of the eyelid. The flaps were designed adjacent to the defects and the incision line corresponding to natural winkle lines on the eyelid. We underm ined the flap under the orbicular muscle, and advanced the flap to cover the def ect. The incisions were closed with 7-0 suture. Results After operation, all flaps survived with primary healing. Follow-up for 3 to 12 months showed that all cases had achieved satisfactory cosmetic effects without secondary deformity. Conclusions It is a simple, safe, an d reliable method to use kite flap for the repair of moderate-sized anterior la mellar eyelid skin defects that are too large to achieve primary approximation. Because kite-flap covers the defect through a direct advancement way without ro tation and twist, there are no dog-ear deformitys present at the pedical area a nd the repaired area looks smoothly. Because of its widely based muscle pedicle which incorporates venous and lymphatic drainage over most of its length, the un desirable pigment deposition is avoided.