重睑成形术后睑粘连畸形的修复

Correction of adhesive folded upper eyelid after blepharoplasty

目的针对临床上常见的由于重睑成形术失误所遗留的严重畸形，尤其表现为重睑线异常宽阔，上睑凹陷粘连并伴有眼轮匝肌下脂肪垫不足者，探索一种能有效改善外观畸形的简便方法。方法在原畸形的重睑切口线痕迹下设计新的重睑线，去除其间的多余皮肤，彻底松解眼睑内组织粘连，切除异常的瘢痕组织，将移位的眼睑结构彻底复位，分离眼轮匝肌下脂肪垫并将其形成蒂在上方的脂肪瓣，在不影响此脂肪瓣血运的前提下，将其向内下旋转达睑板上缘的合适位置固定，充填上睑的腔隙，若仍有残余空间，可以在进行确定重睑皱襞外形及缝合上下缘皮肤的操作后，行自体游离颗粒脂肪进行最后的补充。结果2年中对42例（共80只眼）重睑成形术后上睑粘连畸形进行治疗，其中32例为只应用眼轮匝肌下脂肪垫形成脂肪瓣充填矫正，10例另加颗粒脂肪注射补充，随访30例（共60只眼），外观改善显著，多数受术者十分满意。结论此方法简单易行，效果好，可在临床推广应用。

Objective Adhesion or too highly located folds upper eyelid and even blepharoptosis are common complications after double eyelid operation. The method was designed to correct these deformities. Methods The incision of upper eyelid was designed under the scar. Skin was resected between the former and the new double line, if there was excessive skin. Completely relieve the adhesion until normal tissue was exposed. Expose lateral extension of retro-orbicularis oeuli fat pad. An upper pedicle fat flap was formed after cutting tissues off along bilateral borders. Appropriately and transversely cutting lateral portion of the pedicle made it rotate inside downward with enough blood supply. The fat flap was fixed with released orbital fat and the lower edge of fat flat fixed with upper border of supratarsal to restorate the volume. For severe condition, fat granule injection could be used after the skin was sutured. Results 42 cases （80 eyes） were treated in the past two years. The deformities of 32 cases were corrected by the application of retro-orbieularis oculi fat pad. Fat granule injection was applied for the other 10 patients meanwhile. 30 cases （60 eyes） were followed up for 6 to 24 months. The results were satisfactory. Conclusion The methods are performed easily and the results are satisfied. It is worth of recommendation.