桥式眼轮匝肌肌瓣睑粘连术治疗烧伤后瘢痕性睑外翻

Treatment of cicatricial ectropion after burn with bridge orbicularis oculi muscle flap tarsorrhaphy

目的研究桥式眼轮匝肌肌瓣睑粘连术治疗烧伤后瘢痕性睑外翻的效果。方法回顾性分析2006年4月至2020年9月于西湖大学医学院附属杭州市第一人民医院医疗美容科采用桥式眼轮匝肌肌瓣睑粘连术治疗头面部烧伤继发眼睑严重瘢痕挛缩导致睑外翻的患者资料。术中松解瘢痕睑缘复位后,于上、下睑松解切口基底部各制备一个眼轮匝肌肌瓣,将肌瓣越过睑裂睑粘连点,进行桥式交叉转移,远端固定于松解切口基底的眼轮匝肌,形成睑粘连;对术中形成的皮肤缺损进行工字形全厚皮片或中厚皮片移植修复,并打包固定。术后1年,确认所植皮片稳定、无睑外翻复发后切开粘连。睑粘连术后至少随访1年,观察有无异物感、结膜囊积脓、皮片成活情况,以及睑粘连成功率、肌瓣抗拉伸效果、皮片回缩率和并发症情况。测量术前及睑粘连切开后睁、闭眼时的睑缘间距。采用SPSS 25.0软件进行数据统计,计量资料采用M(Q 1,Q 3)表示,计数资料采用例数表示。结果共纳入14例患者23只眼,男11例,女3例,年龄41.5(32.5,47.0)岁,烧伤至本次治疗时间13.5(10,24)个月;5例(7只眼)烧伤后未行植皮或睑粘连术治疗,另外9例(16只眼)曾行睑粘连术和(或)皮肤移植。术中植皮面积37 mm×18 mm~52 mm×39 mm。术前23只眼睁眼时上、下睑缘距离为14(12,14)mm,闭眼时距离为6(5,9)mm。眼睑粘连术后,患者无异物感,无感染,皮片全部成活。睑粘连成功率为100%,未发生意外断裂或拉长,患者闭眼时睑粘连组织同步收缩,肌瓣抗拉伸效果好。粘连维持时间为13(12,24)个月,期间无并发症或不良反应发生。半年皮片回缩率为9%(5%,10%)。粘连切开后,睁眼时上、下睑缘距离为9(8,9)mm,闭眼时距离为0(0,0)mm。结论桥式眼轮匝肌肌瓣睑粘连术可以提供长期稳定的睑粘连效果,有效减少眼睑植皮后的皮片挛缩,治疗烧伤后睑外翻的效果比较稳定。

Objective To study the effect of bridge orbicularis oculi muscle flap blepharoptosis in the treatment of post-burn scar contracture ectropion.Methods The clinical data of patients wih post-burn cicatricial ectropion treated with bridge orbicularis oculi muscle flap from April 2006 to September 2020 of Department of Plastic Surgery,Affiliated Hangzhou First People’s Hospital,School of Medicine,Westlake University were analyzed retrospectively.For patients with severe eyelid scar contracture caused by head and face burns,after releasing the scar and resetting the eyelid margin,orbicularis oculi muscle flaps were made at the base of the upper and lower eyelid release incision,crossed the muscle flap over the eyelid adhesion point of the eye fissure,by performed bridge cross transfer,and fixed to the orbicularis oculi muscle at the base of the release incision to form eyelid adhesion.H-shaped full-thickness skin graft or medium-thickness skin graft was performed on the defect wound during the operation.Tie-over dressing fixation in the skin graft area.One year after the operation,it was confirmed that the skin graft was stable and there was no recurrence of ectropion,and then cut the adhesion.Follow-up for more than one year after the operation,foreign body sensation,conjunctival sac pusc,skin graft survival,success rate of eyelid adhesion,anti-stretching effect of muscle flap,skin retraction rate and complications were observed.The distances between eyelid margins preoperative and after incision of eyelid adhesion were measured.SPSS 25.0 software was used for data statistics,measurement data was represented by M(Q_(1),Q _(3)),and counting data was represented by cases.Results Fourteen patients(23 eyes)were included in this study,including 11 males and 3 females,aged 41.5(32.5,47.0)years,and the time from burn to this treatment was 13.5(10,24)months.5 cases(7 eyes)were not treated with skin grafting or blepharoptosis after burn,and 9 cases(16 eyes)were treated with blepharoptosis and/or skin transplantation.The area of skin graft during operation was 37 mm×18 mm to 52 mm×39 mm.Before operation,the distance between the upper and lower eyelid margins was 14(12,14)mm when eyes were open,and 6(5,9)mm when eyes were closed.After eyelid adhesion surgery,the patient had no foreign body sensation and infection,and all the skin grafts survived.The success rate of blepharoptosis was 100%,and there was no accidental rupture or elongation.The eyelid adhesions contracted synchronously when the patients closed their eyes,and the muscle flap had good anti-stretching effect.The duration of blepharoptosis was 13(12,24)months,during which no complications or adverse reactions occurred.The average skin graft retraction rate was 9%(5%,10%)in half a year.After incision of the orbicularis oculi muscle flap,the distance between the upper and lower eyelid margins was 9(8,9)mm when the eyes were open,and 0(0,0)mm when the eyes were closed.Conclusion Bridge orbicularis oculi muscle flap tarsorrhaphy can provide long-term tarsorrhaphy,effectively reduce skin contracture after eyelid skin grafting,and has a stable therapeutic effect on postburn ectropion.