游离足背皮瓣串联胫前筋膜瓣治疗放疗后严重眶窝软组织畸形

Anophthalmic orbital reconstruction with free dorsalis pedis flap and anterior timbial fascial flap transfer following orbital radiation

目的:探讨以吻合血管游离足背皮瓣串联胫前筋膜瓣的方式治疗视网膜母细胞瘤眼球摘除及辅助放疗后严重无眼球眶窝软组织畸形的临床疗效。方法:共收治6例视网膜母细胞瘤行眼球摘除及眼眶放射治疗后眶窝严重畸形的患者,应用冠状切口眶截骨重建眶骨支架后,根据结膜囊缺损的大小及颞部的凹陷范围设计足背及胫前串联皮瓣,显微吻合游离皮瓣血管蒂,再造患侧结膜囊及充填颞部凹陷畸形。结果:移植皮瓣全部成活,经12～24个月随访,4例眼窝、颞部凹陷明显改善。结膜囊内义眼预置模固定塑形3个月后,结膜囊深度良好、义眼片佩戴后外形满意;1例眶窝丰满度仍不足,行二期义眼座植入术矫正;另1例则因结膜下穹隆过浅,行自体硬腭黏膜移植修复。足背供区,5例愈合良好,1例延期愈合。结论:游离足背皮瓣串联胫前筋膜瓣能一期用于放疗后无眼球眶窝畸形的眼窝再造和结膜囊成形,以及填充颞部软组织缺损,佩戴眼片后外观满意。

Objective To investigate orbital reconstruction and soft tissue restoration with free dorsalis pedis flap and anterior tibial fascial flap transfer after ophthalmectomy and subsequent radiotherapy for retinoblastoma. Methods A total of six patients with anophthalmic socket deformity due to ophthalmectomy and orbital radiation were included in this study. The orbital bony frame was rebuilt by osteotomy with a coronal incision. According to the size of conjunctival defect and the extent of temporal depression, dorsalis pedis flap along with anterior tibial fascial flap was collected, with microsurgical vessel anastomoses, to reconstruct the conjunctival sac and fill the depressed temporal area. Results All the flap grafts survived. During a follow-up of 12 to 24 months, the structure of the eye socket and the appearance of the temporal area were markedly improved in 4 patients. After 3-month configuration with a artificial eye, an ideal depth of the conjunctival sac was achieved and the appearance with an artificial eyepiece was satisfied. Orbital implantation was performed on one patient due to disatisfication of the orbital fullness and autogenous hard palatal mucosa transplantation on another patient for his shallow inferior conjunctiva fornix. Delayed donor site healing in the dorsum pedis occurted in one patient. Conclusions Dorsalis pedis flap along with anterior timbial fascial flap can be used for anophthalmic orbital reconstruction, conjunctival configuration, and temporal soft tissue restoration, with a satisfied appearance on those with an artificial eyepiece.