岛状皮瓣修复瘢痕性睑外翻

Repair of cicatricial eyelid ectropion with axial island flaps

目的探讨眼轮匝肌蒂颞部岛状皮瓣与颞浅动脉蒂反流轴型耳后岛状皮瓣在修复瘢痕性睑外翻中的应用,提高睑外翻矫正后所致皮肤缺损的美学修复效果。方法自1998年2月以来,对18例瘢痕性睑外翻,采用眼轮匝肌蒂颞部岛状皮瓣旋转180°移位修复13例,皮瓣最大面积2.7cm×3.6cm;采用颞浅动脉蒂反流轴型耳后岛状皮瓣经面部皮下隧道转移修复5例,皮瓣最大面积3.1cm×5.4cm。结果1例反流轴型耳后岛状皮瓣术后出现静脉回流障碍,经对症处理后仅皮瓣远端部分表皮坏死,Ⅱ期植皮后治愈,其余17例皮瓣完全成活。随访6个月,睑外翻矫正,皮瓣颜色、质地与眼周皮肤相近,供区瘢痕不明显。结论根据睑外翻程度,可制备颞部岛状皮瓣或耳后岛状皮瓣转移。前者适用于修复较小面积的皮肤缺损,后者适用于修复较大面积的皮肤缺损。

Objective To investigate the application of temporal island flaps pedieled with orbieularis oculi muscle and contraflow axial postauricular island flaps pedicled with arteria temporalis superficialis in correcting the skin defects of cicatricial eyelid ectropion to enhance the aesthetic effect of corrected defects. Methods From February 1998, among 18 cases with cicatricial eyelid ectropion, 13 cases were repaired by temporal flaps pedicled with orbicularis oculi muscle, and these flaps were transferred with a 180 degree rotation to cover eyelid defects; the largest flap size was 2.7 cm×3.6 cm; 5 cases were repaired with contraflow axial postauricular island flaps transferred through a subcutaneous tunnel, and the largest flap size was 3.1 cm×5.4 cm. Results After 6 months follow up, the flaps in 17 cases survived successfully with good color, texture and contour, and 1 case treated with a contraflow axial postauricular island flap required secondary surgery because of partial epidermal necrosis at the end of the transferred flap due to the obstruction of venous return in the early postoperative stage. No visible scar appeared at the donor site. Conclusion According to the size of the eyelid defect, temporal and postauricular flaps can be prepared for the reconstruction of eyelid skin defects. The former may be used for correcting smaller eyelid defects and the latter for larger eyelid defects.