颞面部超大转移皮瓣联合游离皮瓣在上下睑全层再造中的应用观察

Application observation of temporal facial oversized flap combined with free flap in upper and lower eyelid full-thickness reconstruction

目的探讨颞面部超大转移皮瓣联合游离皮瓣在上下睑全层再造中应用的价值。方法回顾性分析我院1998年3月～2012年4月收治入院的眼睑的全层缺损患者,其中外伤1例,基底细胞癌6例,睑板腺癌3例,鳞状细胞癌2例。因缺损区面积较大,宽>40mm,长>70mm。带蒂皮瓣较大,供皮区严重缺损,采用游离皮瓣修复整形。结果本研究中12例术后观察6～12个月,均于术后6个月行睑缘切开。功能、外观恢复良好者7例,能正常开睑及闭眼。无瘢痕形成。有2例因上睑提上睑肌切除较长,上睑提高不佳,与另一眼不对称,不能完全闭眼,但无一例暴露性角膜炎发生。有2例睑裂长度小于另一眼睑裂3mm导致不够美观。结论采用颞面部超大转移皮瓣联合游离皮瓣在上下睑全层再造术可有效治疗颞面部超大缺损,效果良好,适合在上下睑再造术中皮肤层修复推广应用。

Objective To investigate the application value of temporal facial oversized flap combined with free flap in upper and lower eyelid full-thickness reconstruction. Methods The patients with eyelid full thickness defects in our hospital from March 1998 to April 2012 were retrospectively analyzed. One case, was trauma, 6 cases with basal cell carcinoma, 3 cases with sebaceous carcinomas and 2 cases with squamous cell carcinoma. The defect area was bigger, the wider was wider than 40mm, the length was greater than 70 mm. The pedicle flap was bigger, the donor sites were seriously defected, used plastic surgery. Results In this study, 12 cases were observed after surgery for 6 to12 months, when 6 months after surgery they were all given line palpebral incision. 7 cases＇ function and appearance had recovered well, they could speculum and close eyes normally, had no scar formation. 2 cases＇ upper eyelid levator resection were longer, the upper eyelid improved poor and asymmetry with the other eye, the 2cases could not close eyes completely, but no one had exposure keratitis.2 cases palpebral fissure length was 3 mm less than the other eyelid fissure, less attractive. Conclusion It can effectively treat temporomandibular facial large defect by temporal facial oversized flap combined with free flap in upper and lower eyelid full-thickness reconstruction. It＇s worthy for popularization and application.