上睑板结膜瓣联合局部皮瓣重建下睑广泛全层缺损

Reconstruction of widely full-thickness defect of lower eyelid with upper tarsalconjunctival flap combined with local flaps

目的 探讨上睑板结膜瓣联合单个或多个局部皮瓣在下睑广泛全层缺损修复中的应用效果.方法 采用上睑板结膜瓣修复下睑广泛全层缺损22例,全部缺损长度均大于下睑全长1/2,随后设计一个或多个邻近的局部皮瓣覆盖残留皮肤创面.其中,13例联合单个局部皮瓣,9例联合2个局部皮瓣,共计31个局部皮瓣.术后4～6周,行Ⅱ期断蒂睑缘修整术.结果 Ⅰ期术后,1个鼻旁皮瓣于第4天发生远端部分坏死,其余30个皮瓣（21例）均完全存活.18例患者断蒂后随访3～24个月,除1例有下睑外伤手术史的患者,下睑呈轻度退缩外,其余患者均获得满意的功能与外观.结论 采用上睑板结膜瓣联合单个或多个局部皮瓣修复广泛下睑全层缺损,安全可靠,功能与美容效果均较满意.

Objective To introduce the reconstruction of widely full-thickness lower eyelid defect with the upper tarsoconjunctival flap combined with single or multiple local flaps. Methods The upper tarsoeonjunctival flap was used to repair large lower eyelid defects on 22 patients, All the lengths of lower eyelid defects were grea- ter than a half of the full length, so one or more neighboring local flaps were designed to cover the wounds. A- mong 22 cases, 13 were treated with combined single local flap, 9 with two local flaps （total 31 flaps）. The see- ondary operation off cutting the pedicle and trimming the palpebral margin was performed at 4 ~ 6 weeks postoper- atively. Results All 30 flaps on 21 patients survived completely except for one paranasal flap with the part distal necrosis at 4 days after primary surgery. Following up was performed on 18 patients for 3 months to 2 years after cutting the pedicles, all were satisfied with the functionality and appearance except one patient with a surgery his- tory of lower eyelid trauma surgery occurred mild eyelid retraction. Conclusion It is a safe and reliable method for the patients with widely full-thickness lower eyelid defect reconstruction to be treated with tarsoconjunctival flap combined with single or more local flaps.