重睑成形术后过宽重睑的修复

Repair of over-wide eyelid fold after double eyelid plasty

目的修复重睑成形术后重睑过宽而导致的外观缺陷及生理功能障碍。方法自2005年3月至2007年10月,根据过宽重睑的形成原因及组织损伤程度,对37例重睑过宽患者采用相应的术式。设计新重睑线高度约6 mm,适当去除原重睑线及新重脸线之间的皮肤;于提上睑提肌表面向上广泛剥离,解除重睑术后造成的粘连;彻底释放眶隔脂肪,并均匀平置于提上睑提肌及其腱膜表面。如眶隔脂肪量不足或已被去除,可选用额肌筋膜瓣代替。折叠缝合提上睑肌4～8 mm后,缝合形成新重睑。结果术后随访其中的29例患者3～12个月,其中19例患者重睑线自然流畅,双侧对称,视物清晰,睁眼沉重感消失,角膜暴露正常,3个月后睑闭合完全。其中1例患者因单侧发生血肿,使重睑线不流畅;3例患者上睑有瘢痕增生;1例患者轻度上睑下垂;5例患者上睑稍凹陷,经自体脂肪颗粒填充后得以矫正。结论过宽重睑不仅影响外观,而且也影响上睑的生理功能。手术是修复其组织量不足和恢复正常生理解剖的途径,从而恢复正常的外观和生理功能。

Objective To explore suitable methods for correction of over- wide eyelid fold according to its cause, and the degree of the tissue injury to restore the patients＇ normal appearance and function. Methods Form Mar. 2005 to Oct. 2007, the fold of the upper eyelid with over - wide eyelid fold was repaired in 37 cases by performance of the operation described below. The procedure was designed for a width of about 6 mm and the skin between new and old fold lines was removed if the skin was sufficient to repair the eyelid. The operation was performed by undermining the tissue over the Ievator palpebrae superior muscle and releasing the adhesion between the skin and the levator palpebrae superior muscle, followed by opening of the orbital septum was and using the fat which was released to cover the levator aponeurosis. If the fat was insufficient to cover the aponeurosis, the frontal muscle fascia was employed to replace the fat. The levator palpebrae superior muscle was folded 4 - 8 mm and sutured to build a new eyelid fold. Results Thirtyseven patients were treated by this method and 29 of these cases were followed for 3 12 months, after which 19 cases were satisfied with their appearances. The patients could close their eyes completely at 3 months after the operation. Complications included one case with hematoma on one side; 3 cases with subcuta- neons scar hyperplasia; 1 case with slight ptosis of the upper lid; and 5 cases with the hollowing of the upper eyelid which was eorrected by autologous fat transplantation. Conclusion The key point for repair of the over - wide eyelid fold is to restore its normal anatomic structure and replenish the lost tissue with fat or/and muscle transplantation.