游离皮瓣在眶窝重建中的应用

Eye socket reconstruction with free flap

目的评价游离皮瓣移植矫正眶窝凹陷畸形的效果。方法选择48例眶窝凹陷患者,均予游离皮瓣移植,其中24例采用前臂游离皮瓣,2例采用肩胛皮瓣,22例采用上臂外侧皮瓣。利用显微外科吻合技术将游离皮瓣移植于眶窝内,充填并重建眶窝形态。结果术后随访4～60个月,所有眶窝内移植的皮瓣均成活,未出现坏死与感染。患者术后均出现不同程度的下睑退缩,行前臂游离皮瓣移植者中,17例上睑仍残存凹陷,其中6例凹陷﹥3mm;Ⅱ期行颞浅筋膜瓣移植术。2例行肩胛皮瓣移植者,术后眶窝臃肿,Ⅱ期行皮瓣减薄术。行上臂外侧皮瓣移植术者中,10例术后眶窝外侧血管蒂周围臃肿,行二次皮瓣减薄。术后外观满意,义眼配戴良好。结论游离皮瓣移植可以矫正重度的眶窝凹陷畸形,但应严格限制其适应证。

Objective To evaluate the effect of eye reconstruction with free flap. Methods Free flap transfering was underwent in 48 patients of contracted eye socket and anophthalmos. The forearm free flap was utilized in 24 patients, the scapular flap in 2, the lateral arm free flap in 22. Free flap with microvascular anastomoses was transferred into contracted eye socket. Eye socket was reconstructed in one stage operation. Results All patients were followed up for 4 to 60 months. All flaps survived completely and yielded a properly fitting ocular prosthesis. The appearance of the reconstructed socket was improved significantly. Conclusion Free flap is effective for reconstruction of severe contracted eye socket. But the indication should be restricted limited.