重睑术后瘢痕导致外形不佳的手术修复

Surgical repair of bad eye state caused by double eyelids line scars

目的探讨重睑术后瘢痕所致外形不佳的修复方法。方法术前充分与患者沟通，根据原瘢痕的位置、宽度及皮肤松弛度设计新切口。彻底松解瘢痕粘连，将下缘靠近切口的眼轮匝肌与睑板前组织在新设计的重睑线位置缝合固定，以确定重睑形态，间断缝合睑板前全层组织以修复凹陷瘢痕，最后连续锁边严密对合皮肤。结果2014年11月至2016年9月修复重睑术后瘢痕患者583例，随访3个月到1年，549例闭眼时完全不可见瘢痕折皱线；19例手术切口平整，但仍留有宽度〈1mm瘢痕；15例有改善，但仍有宽度〉1mm的轻度凹陷性瘢痕或者仍有阶梯感。结论重睑术后瘢痕导致的不良形态值得临床重视，合理手术，妥善缝合固定可以有效修复畸形，改善外观。

Objective In order to explore the method to correct double eyelids line scars and to present its therapeutic schedule, curative effects, pathogenesis and precautions. Methods Surgical incisions were designed based on preoperative communication, original scars location and skin elasticity. Scar contracture and synechia was relaxed thoroughly. The pretarsal orbicularis oeuli muscle of the lower incision margin was fixed to the pretarsal fascia on the new designer location of double eyelid line to firm shape. Complete pretarsal layer tissue were joined layer by layer with interrupted suture. Finally, the skin was sutured closely by locking stitch technique. Results From November 2014 to September 2016, 583 eyes with unsatisfied double eyelid scars were treated. Patients were followed up for 3 months to 1 year with sustained aesthetic. There is no visible man-made crease in 549 eyes under eye-closed state. Less than 1 mm wide scars with smooth surface were showed on 19 eyelids. Mild depressed or more than 1 mm wide scars still remained in 15 eyes with improved appearance. Conclusions Unsatisfied appearance caused by double eyelids line scars must be paid highly attention in clinical setting. The appearance can be effectively improved by proper surgical procedures and appropriate suture and fixation.