带蒂眶隔内脂肪瓣牢固内固定在泪沟型眼袋治疗中的应用

Application of Pedicled Orbital Septum Fat Flap Rigid Fixation in Lower Eyelid Blepharoplasty

【目的】探讨带蒂眶隔内脂肪瓣的牢固内固定在泪沟型眼袋畸形矫正术中的应用效果。【方法】对2018年1月至2021年3月期间,因眼袋伴泪沟凹陷畸形就诊于中山大学附属第三医院整形烧伤外科,并行泪沟型眼袋矫正术的81例患者的临床资料进行回顾性分析。该组病例根据患者具体情况选择外路法或内路法眼袋畸形矫正术,术中在轮匝肌下充分剥离至泪沟下方区域,将带蒂眶隔脂肪瓣牢固内固定于上颌骨前间隙及颧骨前间隙的骨膜或骨膜前脂肪上,外路法同时去除多余皮肤及眼轮匝肌矫正眼袋畸形。【结果】本组病例术后随访3~12个月,术后眼袋及泪沟凹陷畸形均得到明显改善,且达到眶下区年轻化的效果。其中2例术后淤血较重,1例发生单侧轻度眼睑外翻,1例出现单侧面中下部麻木,3例内路法患者术后有异物感。上述症状均于2周至3月内消失;余患者无并发症发生。【结论】带蒂眶隔内脂肪瓣的牢固内固定应用于伴泪沟凹陷畸形的眼袋患者,减少了眶隔脂肪移位、回缩的风险,术后美容效果良好,并发症发生率低。

【Objective】To study the value of pedicled orbital septum fat flap secured fixation in lower eyelid blepharoplasty.【Methods】In this retrospective study,81 patients diagnosed as bulgy lower eyelid with tear trough deformity who underwent this procedure at the Department of Plastic Surgery of the Third Affiliated Hospital of Sun Yat-sen University between January 2018 and March 2021 were reviewed.Through a percutaneous or transconjunctival incision,the orbicularis oculi were completely released over tear trough deformity.And orbital septum fat was released and firmly sutured to deep fat pat or periosteum as a flap.Extra orbital septum fat,and extra skin for percutaneous approach was excised to correct bulgy lower eyelid.【Results】The follow-up was three to twelve months.Bulgy lower eyelid and tear trough deformity were significantly improved.Among them,two patients had hematoma,one patient had eyelid ectropion,one patient had palsy of one side of the middle and lower face,three patients who underwent transconjunctival incision had foreign body sensation,and all of them recovered after two weeks to three months.No other complications were reported.【Conclusion】Pedicled orbital septum fat flap secured fixation in lower eyelid blepharoplasty shows great effect for bulgy lower eyelid with tear trough deformity,and maintains low restoration rate and low complication.