岛状穿支皮瓣或筋膜瓣修复眶内容剜除术后眶周组织缺损的临床观察

Clinical observation of repairing periorbital tissue defect after orbital enucleation with island perforator flap

目的探讨穿支皮瓣或筋膜瓣修复眶内容剜除术后复杂组织缺损的适应证、安全性和有效性。方法自2016年9月至2020年12月,解放军总医院第三医学中心眼科医学部按照眶周知名动脉的分布特点,选取以知名动脉为穿支蒂的岛状皮瓣或筋膜瓣,修复眶内容剜除术后复杂组织缺损患者共16例(16只眼),缺损面积为3.0 cm×3.0 cm~14.0 cm×14.0 cm,皮瓣面积为4.0 cm×4.0 cm~15.0 cm×15.0 cm。术后随访3~6个月,观察皮瓣成活及外观等情况。结果本组患者皮瓣成活良好,皮瓣颜色与缺损周围皮肤相近,质地柔软,皮肤痛温觉等功能良好。其中,2例行颞浅穿支筋膜瓣移植后即时断层皮片移植,2例皮管穿支皮瓣及二期手术断蒂修复。1例术后1个月因皮瓣静脉瘀滞导致表皮坏死,行全厚皮片游离植皮术,术后全厚皮片全部成活。结论穿支皮瓣及筋膜瓣具有血供确切、改善"猫耳"外观,形态较理想,移植皮瓣质地良好、厚度适中利于后期放疗的早期介入等优点,是修复眶内容剜除术后眶周软组织缺损的良好皮瓣。

Objective To investigate the indications, safety and effectiveness offascia-pedicled perforator flap for repairing tissue defects after orbital enucleation. Methods From September 2016 to Decmber 2020, according to the anatomical distribution of the famous periorbital artery, 16 patients(16 eyes) were selected to repair the tissue defect after orbital content enucleation with island flap formed by the famous artery as fascia pedicled and transferred to the defect area through subcutaneous tunnel. The defect area was 3.0 cm×3.0 cm~14.0 cm×14.0 cm, the flap area was 4.0 cm×4.0 cm~15.0 cm×15.0 cm. The survival and appearance of the flap were observed after 3 to6 months follow-up. Results The skin flaps survived well. The skin flaps had soft texture and good sensory function. Among them, 2 cases of perforating branch skin flap needed second stage operation to cut the pedicle, and 1 case had venous reflux disorder in early postoperative stage. After active treatment, the skin flap survived well. One case underwent full-thickness free skin grafting 1 month after operation due to epidermal necrosis due to venous stasis. Conclusion Subcutaneous pedicle perforators flap with blood supply, overcome the cat ear tissue thickness moderate texture is more advantageous to improve the appearance, flap late radiation and chemotherapy of the advantages of early intervention, gouge is repairing orbital contents in addition to good skin flap of large peri-orbit tissue defect after surgery.