下睑缘切口皮瓣延伸肌皮瓣法切除睑袋的效果观察

Effect of skin flap expanded with myocutaneous flap through the lower eyelid margin incision on the lower blepharoplasty

目的探讨下睑缘切口皮瓣延伸肌皮瓣法切除睑袋的临床效果。方法于下睑缘睫毛根下1mm处平行下睑缘设计切口，由内眦至外眦，经外眦处与水平线呈15°～30°处向外下方斜行切开3～7mm，先向下皮下剥离约5mm，再切开眼轮匝肌，形成上方为皮瓣下方为肌皮瓣的复合瓣，复合瓣后方的眶隔脂肪充分显露，以眶下缘平面为基准，直视下切除疝出的眶隔脂肪，对有“泪槽”凹陷者将眶隔脂肪转移填充凹陷至下睑平整，最后，扇形切除多余的皮肤和肌肉，间断缝合切口。按照睑袋切除术后满意度标准，对术后效果进行评价，并记录各种并发症的发生情况。结果术后随访1～12个月，按照术后满意度评定标准，患者的满意率82％（262／319）；基本满意率14％（45／319）；不满意率4％（12／319）。本组中43例出现并发症，如轻度复视、轻度睑外翻、血肿等，均经术后7d至3个月逐渐恢复。但14例血肿患者中，有2例在术后6个月行手术切除血肿后，外观改善；6例术后7d拆线时出现切口裂开，经医用胶水粘合后恢复。所有患者术后睑袋畸形均得到不同程度地矫正，下睑皮肤皱纹明显减少或消失，瘢痕不显，无严重的并发症发生。结论采用下睑缘切口皮瓣延伸肌皮瓣法修复中老年人下睑皮肤松弛，效果良好，并发症少，值得临床推广应用。

Objective To investigate the effects of skin flap expanded with myocutaneous flap through the lower eyelid margin incision on the lower blepharoplasty. Methods At 1 mm to eyelash root, an incision was made paralleiing to the lower eyelid margin from the medial to lateral canthus and it extended laterally downward with the angle from 15° to 30°and the length from 3 to 7 mm. After about 5mm downward dissection subcutaneously, the orbiteularis oculi was cut through to form a composite flap with upper skin flap and lower myocutaneous flap. The orbital fats were exposed behind the composite flap. Under direct vision, the hernia fat was excised in accordance with the orbital plane. If the tear trough existed the fat was transferred to fill the de- pression until the lower eyelid became smooth. Finally, the excessive skin and muscle were excised in a fanlike way, and the incision was closed with interrupt sutures. The results were evaluated in accordance with the satis- factory criteria for lower blepharoplasty. The postoperative complications were also reported. Results The fol- low-up was performed for 1 to 12 months. According to the satisfactory criteria for lower blepharoplasty, About 82% patients （262/319） were satisfied with the resuhs, 14% patients （45/319） felt basically good, the rest 4% （ 12/319 ） felt bad. Of all cases, 43 underwent minor complications including slight diplopia, slight eversion, haematoma etc. which gradually disappeared after 7 days to 3 months except 2 cases with haematoma healed by surgical ablation at 6 months postoperatively and 6 cases were with had wound dehiscence after remo- ving sutures, which recovered by using the medical glue. The wrinkles of the lateral canthus,the depression of int}＇a-orbital obtained improvement without conspicuous scars and no serious complications. Conclusion The technique using skirl [lap expanded with myocutaneous flap through the lower eyelid margin incision in the lower hlephamplasty can achieve good results with a few complications and might be widely utilized.