颧眶动脉为蒂的眶周穿支皮瓣的解剖学基础及临床应用研究

Anatomic basis and clinical application of periorbital flap pedicled with zygomatic orbital artery

目的探讨应用颧眶动脉为蒂的眶周穿支皮瓣修复眼睑外翻及缺损的临床效果。方法(1)安徽医科大学第一附属医院整形外科对10具新鲜尸体予明胶氧化铅灌注后,行一次性动脉造影、螺旋CT扫描,将DICOM数据导入Mimics 17.0进行快速体绘制及三维重建,观察颧眶动脉来源及穿支的分布规律等。(2)2012年7月至2017年7月,安徽医科大学第一附属医院整形外科应用颧眶动脉为蒂的眶周穿支皮瓣修复眼睑外翻及缺损患者18例,年龄28~75岁,男10例,女8例。切取皮瓣宽与缺损宽度相同,长为缺损长度的2~3倍,面积为0.3 cm×1.5 cm^2.0 cm×3.0 cm。结果(1)颧眶动脉起源于颞浅动脉,向上约至耳前与外眦角连线中点位置,水平向外眦角延续,在眶外侧1 cm偏下方分为上、下睑动脉弓。(2)临床应用颧眶动脉为蒂的眶周穿支皮瓣修复眼睑外翻及缺损18例,皮瓣均成活,愈合良好,经1个月至2年随访,色泽、质地、外形功能恢复较好。结论以颧眶动脉为蒂的眶周穿支皮瓣血供稳定可靠,且颞部供区的色泽、质地与受区相似,供区隐蔽可直接拉拢缝合,是修复睑外翻及睑缺损的较好方法。

Objective To explore the clinical application effect of the orbital periorbital perforator flap pedicled with zygomatic artery to repair the defect of eyelid ectropion and the defect after tumor resection.Methods(1)Perfused 10 fresh cadavers gelatin lead oxidate with one-time arteriography and CT spiral scanning,and imported DICOM data into Mimics 17.0 for rapid body mapping and three-dimensional reconstruction,and observed the source of zygomatic orbital artery and distribution rules of perforating branches.(2)From July 2012 to July 2017,18 clinical cases were repaired by orbital periorbital perforator flap pedicled with zygomatic artery,the flap was cut with the same width as the defect width,and the length of the flap was 2 to 3 times the defect length,with an area of 0.3 cm×1.5 cm to 2.0 cm×3.0 cm.Results The zygomatic orbital artery originated from the superficial temporal artery,extending up to about the midpoint of the line between the anterior ear and the lateral canthus.The clinical application of the orbital periorbital flap with the perforating branch of the zygomatic orbital artery in 18 cases survived and healed well.After 1 month to 2 years of follow-up,the color,texture and shape function recovered well.Conclusions The orbital periorbital flap with the perforating branch of the zygomatic orbital artery is a good method for reconstruction of ectropion and palpebral defect due to its reliable movement and the arterial arch connected with the orbicularis suborbicularis.