下眼睑缺损修复的临床研究

Clinical study on low eyelid tissue defect repair

目的探讨下眼睑缺损修复的方法与疗效。方法选择14例下眼睑皮肤缺损的患者,采取游离植皮,下睑部分复合组织缺损选用邻近皮瓣,下睑全层缺损应用耳后乳突区反流轴型皮瓣及额部岛状皮瓣加自体耳软骨、肋软骨、口腔黏膜复合组织行移植再造。结果植皮及皮瓣均成活良好,供区、受区一期愈合;1例患者术后1周心肌梗死死亡,其余患者下睑外观及功能恢复满意。结论下睑皮肤软组织缺损,小面积者可植皮,大范围时需用局部皮瓣以防止术后皮肤挛缩、睑外翻;下睑全层缺损的再造要兼顾皮肤、睑板和结膜:耳后反流轴型皮瓣供区隐蔽,术后形态恢复满意;额部皮瓣血供可靠,但供区影响外观。自体耳软骨较肋软骨更适合替代睑板。切取口腔黏膜对外观功能无影响,宜作为睑结膜再造的首选。

Objective To explore the method and experience of repairing low eyelid tissue defect.Methods 14 cases with low eyelid tissue defect were enrolled.Using free skin graft,for partial defection with complex-tissue,adjacent skin flap was chosen,but for whole low eyelid defection,after-ear reverse-flow flap,forehead flap,ear cartilage,rib cartilage and oral cavity were chosen.Results All the flaps and skins survived completely with primary healing both in donor and recipient area.1 case succumbed to myocardial infarction one week after surgery,the other healed with good low eyelid appearance and function.Conclusion Method of dermatoplasty may be selected for little leyelid lack,while skin flap should be selected to prevent skin contraction or ectropion palpebrarum when the defect area was extensive.The reconstruction of complete low eyelid defect should give consideration to skin,ciliary cartilages and ciliary cartilages：after-ear reverse-flow flap has some virtue,which had inconspicuous area and good appearance;forhead flap has reliable blood,but supplying area is urglily;ear cartilage is better than rib cartilage;oral cavity is the first mode of choice of eyelid conjunctiva reconstruction.