额部皮瓣联合睑板结膜瓣在下睑广泛全层缺损修复中的应用

Forehead flap combined with tarsalconjunctival flaps in the reconstruction of widely full-thickness defect of lower eyelid

目的探讨额部皮瓣联合睑板结膜瓣在下睑广泛全层缺损修复中的应用及效果。方法2016年1月至2018年3月海军军医大学附属长海医院收治下睑广泛全层缺损患者9例,全部缺损长度均大于下睑全长一半。设计额部皮瓣联合睑板结膜瓣覆盖下睑缺损处的残留皮肤创面。术后4~6周行二期断蒂和睑缘修整术。结果本组9例额部皮瓣全部存活。1例术后出现下睑退缩,半年后恢复正常。1例因下睑皮瓣肥厚、1例因皮瓣蒂部肥厚半年后进行修薄。余患者术后外观均得到较大改善,没有进行任何修复手术,对手术效果满意。结论额部皮瓣质地好、血供确切、成活率高,在联合睑板结膜瓣修复广泛的下睑全层缺损时能获得良好的手术治疗效果。

Objective To investigate the application and effect of frontal flap combined with tarsalconjunctiva flap in the repair of widely full-thickness defects of the lower eyelid.Methods From January 2016 to March 2018,9 patients with extensive full-thickness lower eyelid defect were admitted to the Plastic Surgery Department of Changhai Hospital Affiliated to the Naval Military Medical University.All the lengths of lower eyelid defects were greater than a half of the full length.Then we designed forehead flaps combined with tarsalconjunctival flaps to cover the wounds.The second stage operation was done after 4-6 weeks to cut the pedicle and dress the eyelid.Results All the frontal flaps of 9 patients survived.One patient had lower eyelid retraction and the lid position returned to normal half a year later.One underwent thinning surgery because of lower eyelid flap hypertrophy and one were because of pedicle hypertrophy.The appearance and function of other patients were greatly improved after surgery,and they were satisfied with the operation effect.No repair operation was performed in the future.Conclusions The frontal flap with good quality of blood supply has a high survival rate and can be used to repair the wide defect of the lower eyelid with tarsalconjunctival flaps.