携带骨膜的以颞浅血管为蒂的额瓣修复下睑全层缺损

Frontal flap pedicled with superficial temporal vessels for the treatment of lower eyelid defects

目的探讨携带骨膜的以颞浅血管为蒂的额瓣在修复下睑全层缺损中的应用效果。方法对6例患者行下眼睑恶性肿瘤切除术，术中冷冻切片检查保障安全切缘。据缺损大小设计额瓣，额瓣切取时皮瓣的远端和下端切开至颅骨，上端则切至骨膜并保留皮瓣上缘1cm的骨膜组织，从远端开始沿颅骨表面掀翻皮瓣，至皮瓣近端再切开骨膜，使切取的额瓣携带骨膜，皮瓣转移至缺损区后，将下端骨膜与皮瓣组织稍行分离后与残留结膜缝合，以替代缺损的球结膜，上端多出来的骨膜外翻与皮肤切缘缝合再造睑缘。供区经适当的游离并旋转缝合关闭创面。结果6例皮瓣全部成活，4例再造睑缘局部有肉芽生成，仅1例较大肉芽应用三氯醋酸处理，肉芽均在术后2～3个月内消失。术后无下睑外翻，患者下睑外观及功能恢复满意。结论携带骨膜的以颞浅血管为蒂的额瓣可同时完成下睑全层缺损的修复，额瓣的硬度及厚度足以支撑眼睑的外形；携带的骨膜可同时修复结膜的缺损，方法简洁，效果满意，具有较高的临床应用价值。

Objective To discuss the effect of frontal flap pedicled with superficial temporal vessels on lower eyelid defects. Methods Six patients underwent excision of lower eyelid malignant tumor and intraoperative freeze section was examined to ensure the safety margin, and designed the forehead flap according to the defect size. The distal and end of the flap is open to the skull when cutting frontal flap. The flap was overturned from the start along the distal surface of the skull to the proximal end of the flap to open the pefiosteum, and then the flap could carry the periosteum. The lower end of the periosteum and skin flap was separated from the skin flap after it was transferred to the defect area, and the residual conjunctival suture was performed to replace the defect ball conjunctiva. The upper end of the extra periosteal was turned out and sutured with skin margin. The wound was closed after proper free and rotating suture of the donor site. Results Six flaps all survived and four cases had partial granulation formation of eyelid reconstruction. Only one case had large granulation. After application of three acetic acid treatments, all of granulation disappeared within 2 3 months after operation. There was no lower eyelid ectropion and after operation, and the appearance and function recovery of the lower eyelid were satisfactory. Conclusions The frontal flap pedicled with the superficial temporal vessels could repair the lower eyelid defect at the same time. The flap was hard and long enough to sustain the appearance of eyelid, and the periosteum could be used to repair the conjunctiva defect. This method was simple, effective, and had high value in clinical aoolication.