内眦韧带固定矫治内眦赘皮的探讨

The investigation of epicanthine correction by medial palpebral ligament fixation

目的探讨应用三角形皮瓣切除或“z”成形术联合皮肤、眼轮匝肌行内眦韧带固定，且能减轻瘢痕增生的内眦赘皮矫治的方法及效果。方法对90例患者分别采用三角形皮瓣切除或“z”成形术联合皮肤、眼轮匝肌行内眦韧带固定术。A组（56例）：将三角形皮瓣切除，暴露眼轮匝肌，分离眼轮匝肌和内眦韧带，将内眦韧带两侧的眼轮匝肌彻底分离、松解，剪除皮瓣内多余的眼轮匝肌。将新内眦点处的皮肤和眼轮匝肌瓣与三角形底边中点（相当于内眦韧带的起点）固定于内眦韧带上。B组（34例）：切开“z”形皮瓣，并分离皮瓣及内眦韧带，将内眦皮瓣向上转移，使新内眦点的皮肤、眼轮匝肌固定于内眦韧带上；向下转移的皮瓣缝合固定于下脸缘切口下的眼轮匝肌上。结果本组共90例患者，28例获随访1～6个月，新内眦成形良好，瘢痕不显，睑裂变长，眼外观自然。结论两种方法均是将新内眦处的眼轮匝肌和皮肤固定在内眦韧带上，能使新建的内眦点具有正常的解剖结构，内眦赘皮不易复发，组织创伤小，切口瘢痕不明显，是矫正内眦赘皮的有效方法。

Objective To explore the method and effect of application of triangle skin flap resection or Z- shaped method combined with skin and orbicularis oculi to fix medial palpebral ligament which lessened the scar hyperplasia in the epicanthine correction. Methods Ninety patients were studied in this group and divided randomly into two groups： the A group and the B group. The patients （56 cases） in the A group were corrected by cutting triangle skin flap to expose musculus orbicularis oculi, the bilateral musculus orbicularis oculi of medial palpebral ligament were dissected and loosened and then the redundant musculus orbicularis oculi was removed. The skin of new medial canthus and the midpoint of the hemline of the triangle （ the start of the medial palpebral ligament） and the muscle flap of orbicularis oculi were fixed onto the medial palpebral ligament. The patients in the B group （34 cases） were corrected by exciding the Z-shaped skin flap under local anesthesia which was further separated from medial palpebral ligament, the skin flap of medial canthus was moved upward, the skin of new medial canthus and the orbieularis oculi were fixed onto the medial palpebral ligament; the skin flap was transferred downward and then sutured and fixed onto the orbicularis oculi under incision of the lower palpebral margin. Results After 1 - 6 months follow-up on 28 of 90 patients, all cases were satisfied with new formed medial canthus, concealed scar, lengthened palpebral fissure and natural eye appearance. Conclusion These two new methods all fix the orbicularis oculi and the skin of new inner canthus onto the medial palpebral ligament to make the new inner canthns which has a normal anatomy structure. They are both effective methods for correcting the epieanthus with such advantages as non-recurrence, minimal invasion and concealed scar.