颞部眼轮匝肌蒂皮瓣修复大面积下睑前层缺损的临床效果研究

Quantitative Study on the Long-term Effect of Temporal Orbicularis Oculi Myocutaneous Flap in Repairing Large Anterior Layer Defect of Lower Eyelid

目的:观察颞部眼轮匝肌蒂皮瓣在眼睑全层重建术中修复大面积下睑前层缺损的远期效果,并对下睑解剖和功能指标进行定量分析。方法:收集2016年1月-2020年1月在河北省眼科医院诊治的大面积下睑前层缺损患者共43例。所有患者眼睑后层根据睑板缺损情况做不同处理,前层均使用颞部眼轮匝肌蒂皮瓣修复,术后随访时间12~36个月。观察指标包括一期愈合情况、皮瓣存活率、皮瓣颜色和平整性,在下睑位置和解剖功能方面通过下睑缘角膜映光点距离(MRD2)、巩膜暴露高度、睑裂闭合不全高度进行定量评价。结果:术后1年复查,43例患者皮瓣均成活良好,颜色和质地与周围皮肤无明显差异,供区瘢痕隐蔽;2例患者出现轻度眼睑内翻,2例患者出现眼睑退缩伴眼睑闭合不全,3例皮瓣肌蒂扭转部位出现臃肿。术后1年MRD2、巩膜暴露、眼睑闭合均较术前降低,差异具有统计学意义(P<0.05)。结论:颞部眼轮匝肌蒂皮瓣具有血供丰富、应用灵活、瘢痕隐蔽等优点,术后远期下睑形态及功能均可达到满意效果,是眼睑重建手术中修复大面积下睑前层缺损的可靠手术方法。

Objective To observe and quantitatively evaluate the long-term effect of temporal orbicularis oculi myocutaneous flap in repairing the anterior layer defect of lower eyelid. Methods A total of 43 patients with large anterior lower eyelid defect diagnosed and treated in Hebei Eye Hospital from January 2016 to January 2020 were collected. The posterior layer of the eyelid of all patients was treated differently according to the tarsal defect, and the anterior layer was repaired with a temporal orbicularis oculi muscle pedicle flap. The postoperative follow-up time was 12 to 36 months. Observation indicators included primary healing, flap survival rate, flap color, and flatness. Moreover, the position and functional recovery of the lower eyelid were quantitatively evaluated using margin reflex distance 2(MRD2), scleral show and lagophthalmos. Results One year after surgery, the skin flaps of 43 patients survived well, the color and texture were not significantly different from the surrounding skin, and the donor site scar was hidden;2 patients had mild eyelid inversion, 2 patients had eyelid retraction with incomplete eyelid closure, 3 flap muscle pedicle The torsion area was bloated. MRD2, sclera exposure, and eyelid closure at 1 year after surgery were all lower than those before surgery, and the difference was statistically significant(P<0.05). Conclusion The temporal orbicularis oculi myocutaneous flap manifested several advantages, such as rich blood supply, flexible application and hidden scar. Meanwhile, the anatomical, functional cosmetic effect of lower eyelid reached satisfied outcome postoperatively. In summery, it is a reliable surgical method to repair the anterior layer defect of lower eyelid.