带蒂颞筋膜瓣结合游离皮片移植眼眶再造术

Reconstruction of orbital defects with superficial temporal fascia flap and skin graft

目的报道应用带蒂颞筋膜瓣转移结合游离皮片移植进行眼眶再造的临床体会。方法对17例因外伤及肿瘤术后等造成的眼窝重度凹陷、结膜囊重度狭窄或眼窝闭锁、义眼无法安放患者,采用带颞浅血管蒂颞浅筋膜瓣转移结合游离植皮进行眼眶再造,筋膜瓣3cm×4cm～8cm×10cm大小,其中外伤致眶内容摘除术后9例,视网膜母细胞瘤术后5例,眼睑黑色素瘤眶内容物摘除术一期修复3例。结果该组颞浅筋膜瓣全部成活,皮片成活后外形平坦无血肿及感染等并发症,经随访6～60个月,再造的眼窝外形满意。其中2例皮片部分坏死,1例补充植皮后愈合,1例换药后自愈;2例因肿瘤复发并远处转移病故,但眼部外形正常。结论带蒂颞浅筋膜瓣血运丰富,易成活,结合皮片移植手术方法简单、创伤小、术后外形好,是眼眶再造的较好选择。

【Objective】 To report the application of the superficial temporalis facial flap（TFF） in the reconstruction of orbital defects.【Method】 17 patients were treated surgically using TMF to reconstruct orbital defects.TMF was designed according to size and locus of defect.The sizes of the flaps ranged from 3 cm×4 cm to 8 cm×10 cm,and used to reconstruct orbital exenteration in 9 patients,retinoblastoma in 5 patients and malignant melanoma in 3 patients.【Results】 During follow-up of 6 months to 5 years,there were no cases of flap loss,except partial necrosis of skin graft in 2 cases.All patients were satisfied with appearance with orbital reconstruction.2 patients died from metastasis,but showed a normal manifestation in reconstructive orbit.【Conclusions】 TMF combined with skin graft is a useful and reliable method to reconstruct the orbital defects.