转移皮瓣联合上睑皮肤松弛矫正治疗较大睑黄色瘤的手术疗效观察

Effect of metastatic flap with upper eyelid correction surgery in the treatment of large xanthelasma

目的探讨双眼上睑皮肤松弛矫正术中转移皮瓣法在较大睑黄色瘤切除术中的临床应用及疗效。方法选自我院2016年7月至2018年11月,14例上睑较大睑黄色瘤伴有皮肤松弛患者,采取转移皮瓣联合上睑皮肤松弛矫正术治疗较大睑黄色瘤。在距上睑缘5~7 mm处设计重睑线(线1),重睑线内侧尽可能低于瘤体,外侧顺鱼尾纹自然延续,依据上睑皮肤松弛程度决定画出重睑上线(线2),线2平于或高于瘤体中线。术中将皮肤松弛矫正术中预切除的合适皮瓣转移至原瘤体处,修复睑黄色瘤切除后的组织缺损,再适度修剪多余皮肤,缝合重睑切口上下唇固定睑板前组织,形成理想重睑。结果随访3~12个月,14例(28只眼)上睑黄色瘤未见复发,转移的皮瓣全部成活且创口均Ⅰ期愈合,皮瓣质地柔软,弹性好,皮瓣颜色与周围上睑皮肤未见明显色差;9例上睑外形良好,2例患者因去皮量不对称而重睑欠对称,术后半年进行调整,1例因切口上唇皮下厚而上睑外侧仍臃肿,2只眼因瘤体过大而重睑弧度欠佳;术后均未出现眼睑外翻和畸形,医患双方满意。结论取自上睑皮肤松弛矫正术中的转移皮瓣,填补睑黄色瘤切除后的组织缺损,可一次性矫正上睑皮肤松弛和治疗较大睑黄色瘤。术后瘤体切除彻底,皮瓣成活率高、重睑形态良好,达到上睑形态美观自然和睑黄色瘤手术治疗的双重效果。

Objective To investigate the clinical application and efficacy of metastatic flap with upper eyelid correction surgery for the treatment of bilateral large xanthelasma. Methods Between July 2016 to November 2018, 14 patients with large xanthelasma and upper eyelid skin sagging received metastatic flap with upper eyelid correction surgery for treatment of their xanthelasma. The double eyelid line(line 1) was designed at 5~7 mm to the upper eyelid margin, with the medial line below the tumor and the lateral line naturally continued, and line 2 was designed according to the degree of upper eyelid skin sagging, which was at or above the middle line of the tumor. During the operation, the pre-excised appropriate skin flap was transferred to the original tumor body to repair the tissue defect after the removal of xanthelasma. Then the excess skin was properly trimmed, the upper eyelid incision was sutured to achieve the ideal double eyelid morphology. Results During the follow-up of 3 to 12 months, 14 cases(28 eyes) had no recurrence of upper eyelid xanthelasma. All metastatic flap survived and wounds achieved first intention healing. The flaps were soft and elastic, with no color difference with surrounding eyelid skins. The shape of the upper eyelid was good in 9 patients. The double eyelid was unsymmetrical in 2 patients due to different amount of skin removal, which was corrected at six months after the surgery. One case had swollen eyelid on the lateral side due to the thick skin of the upper incision, and 2 cases were had undesirable eyelid curve due to the large tumor. There was no upper eyelid malformation or ectropion after the surgery, and both doctors and patients were satisfied.Conclusions Metastatic flap from the upper eyelid correction surgery could be used to fill the tissue defect after xanthelasma resection, which could treat the skin sagging and xanthelasma of the upper eyelid simultaneously. After the surgery, the tumor was completely resected, the flaps all survived and the double eyelid morphology was good. Both natural appearance of the upper eyelid and surgical treatment of the xanthelasma were achieved using this method.