改良肌皮瓣法眼袋祛除术的临床研究

Clinical Study of Mixed Baggy Eyelid Plasty with a New Myocutaneous Flap Method

目的探讨改良肌皮瓣法在混合型睑袋整形术中的应用价值和注意事项。方法 2004年7月～2010年4月以斜切口改良肌皮瓣法行混合型睑袋整形术733例1466只睑袋。于下睑缘下方1～2mm处作横行皮肤切口,再于皮肤切口下方1～2mm作眼轮匝肌斜行切口,钝性剥离肌皮瓣达眶骨缘水平。切开眶隔(横向,长1.5cm),切除突出的眶隔内脂肪。嘱求美者双目向额部凝视,将肌皮瓣平铺后呈斜面剪去多余的眼轮匝肌和皮肤。以7-0单股尼龙美容线连续缝合皮肤。结果术后7d～14个月随访,最终满意率为100%。733例1462只睑袋术后下睑紧绷,皱纹减少或消失;4只睑袋局部脂肪轻度膨出。术后即刻出现复视2例,12h内消失;下睑淤血发青711例1375只睑袋,21只睑袋术后2周消失,其余均在1周内消失。术后睑外翻189例,其中187例于1周内消失,另2例于术后2个月内消失。结论对于混合型睑袋,采用皮肤与肌肉切口错开1～2mm的改良肌皮瓣法,切除突出的眶隔内脂肪、松弛的皮肤和多余的眼轮匝肌,方法安全可靠,疗效显著,睑缘下外形自然。

Objective To investigate the clinical effects and some problems about mixed baggy eyelid plasty with a new myocutaneous flap method.Methods From July 2004 to April 2010,1466 mixed baggy eyelids of 733 patients were performed plasty with a new myocutaneous flap method.Before operation the skin incision line and muscle incision line were marked 1～2mm and 2～3mm below the ciliary margin respectively.During the operation the skin-muscle flap was firstly formed to the lower orbicularis level after the slip-muscle-incision was done.A horizontal periorbital incision about 15mm in size was made near the lower orbital edge.After the orbital fat that teased out of the orbit under the finger pressure was removed,let the patient keep looking toward forehead and cut the excessive skin and muscle.The skin incision was closed continuously with 7-0 mono-bunched Nylon suture.Results Follow-ups were 7d to 14m.733 cases with 1462 mixed lower eyelid bags were satisfied finally with the tense and smooth appearance of the lower eyelid,although there were 4 eyelid bags with local fat prolapse;189 cases with temporary ectropions,187 of them disappeared within 2 weeks,and the other 2 cases recovered during 2 weeks;2 cases with immediate temporary double vision on the operation day.Conclusion With the partial removement of 3 kinds of soft tissues periorbital fat pad、orbicularis muscle and skin through different level skin-muscle-incision,the appearance of the lower eyelid is natural.The new myocutaneous flap method is an ideal plasty for mixed baggy eyelid.