岛状皮瓣一期修复眼睑分裂痣的设计与技巧

The design and technique of one stage treatment of eyelid divided nevus with island skin flap

目的探讨应用邻位及远位岛状皮瓣一期修复眼睑分裂痣的设计与技巧。方法切除眼睑分裂痣上、下睑病变后，根据缺损的部位、形态及面积，选择应用眼轮匝肌蒂岛状皮瓣、耳后SMAS蒂岛状皮瓣或逆行颞浅动脉岛状皮瓣一期修复上、下睑皮肤缺损，供区均直接缝合。练果2003年以来，共收治患者16例，其中应用眼轮匝肌肌皮瓣10例，耳后SMAS筋膜蒂皮瓣3例及逆行颞浅动脉岛状皮瓣3例。切除痣体的最大面积上睑为2．5cm×2．0cm，下睑为4．0cm×3．0cm。1例耳后SMAS筋膜蒂皮瓣及1例逆行颞浅动脉岛状皮瓣术后出现皮瓣远端静脉回流障碍、部分表皮坏死，经换药后自行愈合，其余14例皮瓣全部成活良好。结论根据病变的部位、形态和面积等选择合适的邻位或远位岛状皮瓣修复眼睑分裂痣切除术后皮肤缺损，效果满意，且供区隐蔽、无继发畸形。

Objective To investigate the design and technique of the one stage treatment of eyelid divided nevus with adjacent and distant island skin flap. Methods Under local or general anesthesia, the divided nevus on the upper and lower eyelid were excised totally or partially. According to the location, shape and size of the defect, orbicularis oculi musculocutaneous flap, postauricular SMAS-pedicled flap or reversal superficial temporal artery flap was chosen to repair the defect in one stage. The donor site was closed directly. Results Since 2003,16 patients were treated in this group, with 10 orbicularis oculi musculocutaneous flaps, 3 postauricular SMAS-pedicled flaps, and 3 reversal superficial temporal artery flaps. The largest size of the nevus on the upper and lower eyelid were 2. 5 cm×2.0 cm and 4. 0 cm×3.0 cm, respectively. One postauricular SMAS-pedicled flap and 1 reversal superficial temporal artery flap showed distal venous refluence obstruction and epidermal necrosis in early postoperative stage, which healed through dressing. The other flaps survived completely. Conclusions Treating eyelid divided defects with adjacent or distant island skin flap is a suitable method with satisfactory result and less morbidity in donor sites.