医源性下睑缘缺损及外翻的手术修复

Surgical repair of iatrogenic lower eyelid margin defects and ectropion

目的总结并分析美容性外眦成形及“下睑下至”所致医源性下睑缘缺损及外翻的手术修复方法。方法自2019年1月至2021年9月,海军特色医学中心烧伤整形外科收治12例(23侧)医源性下睑缘缺损及外翻患者。对于睑板部分保留但睑缘部分缺失、下睑外翻、睑结膜显露的患者,采用眼轮匝肌肌皮瓣法修复;对于睑板睑缘部分全层缺失、下睑外翻的患者,采用眼轮匝肌肌皮瓣联合自体掌长肌腱移植法修复。结果所有患者术后获随访6~30个月,平均9个月。皮瓣与移植肌腱全部成活,眼睑外观及功能改善均较满意。结论下睑眼轮匝肌肌皮瓣法可用于睑板部分保留但睑缘部分缺失、下睑外翻、睑结膜显露的修复;下睑眼轮匝肌肌皮瓣联合自体掌长肌腱移植法可用于睑板睑缘部分全层缺失、下睑外翻的修复。

Objective To summarize and analyze the surgical repair methods for iatrogenic lower eyelid margin defects and ectropion caused by cosmetic lateral canthoplasty and"vertical enlargement of the palpebral aperture"operation.Methods From January2019 to September 2021,12 cases(23 sides)were admitted to the Department of Burn and Plastic Surgery at Naval Medical Center for iatrogenic lower eyelid margin defects and ectropion.The lower eyelid orbicularis oculi myocutaneous flap was used for the reconstruction of the patient whose tarsal plate was partially reserved but the palpebral margin was partially excised and with the symptom of ectropion.The lower eyelid orbicularis oculi myocutaneous flap combined with autologous palmar longus tendon grafting was used for the reconstruction of the patient with partial full-thickness loss of the palpebral margin and ectropion of the lower eyelid.Results All patients were followed for6 to 30 months,with an average of 9 months.The flaps and tendon grafts survived well in all cases,satisfactory aesthetic and functional goals were achieved.Conclusion The lower eyelid orbicularis oculi myocutaneous flap can be used for the repair of tarsal plate is partially reserved but the palpebral margin is partially excised and with the symptom of ectropion.The lower eyelid orbicularis oculi myocutaneous flap combined with autologous palmar longus tendon grafting can be used for the repair of partial full-thickness loss of the palpebral margin and ectropion of the lower eyelid.