Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed.All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterioror posterior-layer eyelid defects.The survival rate of the propeller flap,eyelid function and appearance,tumor recurrence rate,and patient satisfaction were evaluated after the surgery.RESULTS:The patients consisted of 12 men and 11 women,aged 31–82y(mean,58.9y).The longest followup time was 5y,and the shortest was 3mo.All the propeller flaps survived well.There was no significant difference in color and luster between the flap and adjacent tissues,and there was no dog ear phenomenon.No obvious scarring was observed.There were no obvious abnormalities of eyelid morphology or function,and no adverse complications such as exposure keratitis,entropion,ectropion,ptosis,and eyelid retraction.No tumor recurrence was found at the time of the last follow-up.All patients were satisfied with the surgical results.CONCLUSION:The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactor y outcomes in terms of eyelid function and esthetics,and merits clinical application.

Reconstruction of eyelid defects using the diplene adhesive membrane

Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane.The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.Results The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.Conclusion Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction,for the surgical treatment of ectropion including recurrent cases,and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction

AIM:To investigate the suitability of a modified Hughes procedure,which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect.METHODS:Patients with full thickness eyelid carcinoma involving more than 50%margin length who underwent surgical resection were retrospectively reviewed in the study.The defects were reconstructed using conjunctival flap with auricular cartilage grafting,covered with myocutaneous flap above.Followed-up time ranged from 12 to 24 mo.Outcomes were classified as“good”,“fair”,and“poor”by evaluating the margin appearance,eyelid appearance,and complications.RESULTS:A total of 42 patients were enrolled in the study(26 males,16 females,mean age,68.6±7.7 y,range:53 to 82 y).The mean defect widths measured 23.2±2.9 mm(range,17 to 28 mm).The mean posterior lamellar defect height was 5.5±1.3 mm(4 to 8 mm).Thirty-seven patients had a“good”outcome(88.1%),5 patients had a“fair”outcome(11.9%),and no one had a“poor”outcome.CONCLUSION:Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect.It can not only achieve satisfied reconstruction,but also preserve intact tarsal plate of the opposite eyelid,avoiding retraction or entropion.

Revisiting the upper eyelid blepharoplasty advancement flap:adaptation for the repair of full-thickness upper eyelid defects—a case series

A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.

Eyelid reconstruction methods:A 10-year review

In ophthalmological practice,eyelid reconstruction is often needed because of the presence of defects that arise after the excision of a tumor or after injuries.Various methods for reconstructing these defects have been previously described.However,it is important to understand the basic principles underlying these techniques and their advantages and disadvantages to ensure the choice of the optimal technique in a particular case.We have analyzed the recent literature on new methods or modifications of existing ones to provide a brief overview of the reconstructive methods of the century for comparison.We searched PubMed and CyberLeninka for articles on restoring eyelid defects reported in the literature over the past 10 years.Most techniques can be considered modified classical reconstruction methods.Postoperative complications included aesthetic defects,such as scarring of the upper or lower eyelid,trichiasis,entropion,and lagophthalmos.Surgeons continue to search for the best methods for complex reconstructive surgery to achieve good cosmetic and aesthetic outcomes.

Repair of Full-Thickness Defects of the Lower Eyelid

The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of the eyelid. A pedicled skin flap from the adjacent region was rotated to cover the defect. The results in 4 patients were all satisfactory. The keypoint of the operation is the selection and design of an ideal pedicled skin flap.

眼睑肿瘤切除后不同眼睑缺损修补方式的疗效比较

目的比较眼睑肿瘤切除后不同眼睑缺损修补方式的修复效果。方法回顾性分析90例眼睑恶性肿瘤患者的临床资料。所有患者行眼睑肿瘤切除术治疗,术后修复眼睑缺损,根据修复方式分为观察组(n=34)和传统组(n=56)。观察组采用异体巩膜移植修补,传统组采用自体唇黏膜和邻近皮瓣转移修补。比较2组患者的修复效果,修复前后眼睑形态及美容效果。比较2组术后1个月的并发症发生情况。结果修复后,观察组总有效率为94.12%,高于传统组的73.21%,差异有统计学意义(P<0.05)。修复后,2组眼睑裂高度、长度差值低于术前,且观察组低于传统组,差异有统计学意义(P<0.05)。修复后,观察组美容效果评分为(1.65±0.27)分,高于传统组的(1.36±0.20)分,差异有统计学意义(P<0.05)。修复后,观察组总并发症发生率为11.76%,低于传统组的30.36%,差异有统计学意义(P<0.05)。结论采用异体巩膜移植修复眼睑缺损的临床效果较佳,可有效改善眼睑形态和美容效果,且并发症发生率低。

Extensive full-thickness eyelid reconstruction with rotation flaps through "subcutaneous tunnel" and palatal mucosal grafts

· AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions.This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining.·METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized,leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.·RESULTS: All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible.The defects were repaired completely, and the evaluations showed satisfactory function and appearance.·CONCLUSION: This technique is an improved singlestage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.

局部皮瓣联合异体巩膜移植修复眼睑及其周围皮肤缺损疗效观察

目的:观察局部皮瓣联合异体巩膜移植修复眼睑及其周围皮肤缺损的临床效果。方法:选取2019年1月-2021年1月笔者医院收治的90例眼睑恶性肿瘤切除术后眼睑及周围皮肤缺损患者,采用随机数字表法分为观察组和对照组,各45例,对照组采用异体巩膜移植修复,观察组在此基础上联合局部皮瓣修复,比较两组修复效果,修复前后睑裂长度、眼睑高度差值以及修复后6个月瘢痕宽度、瘢痕颜色、弹性、平整度、眼睑形态恢复程度、外观满意度评分,以及并发症发生情况。结果:观察组修复总有效率高于对照组(P<0.05);两组修复后睑裂长度、眼睑高度均较修复前降低(P<0.05),且观察组低于对照组(P<0.05);观察组修复后6个月瘢痕宽度小于对照组,瘢痕颜色、弹性、平整度、眼睑形态恢复程度、外观满意度评分均高于对照组(P<0.05);观察组术后上睑下垂、睑缘切痕等并发症总发生率低于对照组(P<0.05)。结论:局部皮瓣联合异体巩膜移植修复眼睑及其周围皮肤缺损疗效显著且并发症少,术后眼睑形态及美学效果良好。

风筝皮瓣及旋转皮瓣在修复眉眼前层缺损中的应用

目的:探讨风筝皮瓣及旋转皮瓣在眼外伤或良性肿物切除术后造成眉眼前层缺损的疗效,评价其预后、修复效果以及美学评分改变。方法:收集2018年5月至2020年5月34例眉/眼外伤或因良性肿物行手术切除患者,其眉眼前层缺损最大直径不超过眼长度1/2,根据创面缺损位置、范围,设计沿皮纹方向的缺损邻接部位局部风筝皮瓣及旋转皮瓣,推进滑行局部转移皮瓣向缺损区移位一期修复缺损。随访6个月观察术后皮瓣愈合情况、缺损的修复效果、并发症、患者满意度,比较手术前后美学评分。结果:所有皮瓣全部成活,切口均为I期甲级愈合,局部皮瓣的皮肤色泽、厚薄、毛发情况、质地以及眉毛走行分布与未手术侧基本一致,皮瓣创周器官组织形态无明显改变,皮瓣上眉毛生长良好,手术切口隐蔽在肌肤纹路处、瘢痕增生不鲜明,所有患者无需再次手术。缺损部无臃肿,双侧连续性以及对称性良好,无眉眼变形、倒睫、睑内外翻、上睑下垂等出现,眉/眼组织形态美观、功能良好。患者对手术效果比较满意。患者术后1 d及1、3、6个月的美学评分分别为(73.50±7.79)、(76.97±6.84)、(82.21±6.11)和(87.06±6.07)分,均高于术前的(50.59±9.71)分,比较差异均有统计学意义(均P<0.05)。结论:应用风筝皮瓣及旋转皮瓣I期修复眉/眼皮肤软组织缺损,可较好地恢复眉/眼形态和功能,患者对缺损修复效果满意度高,能取得较高的美学评分,操作简单易行,效果可靠,无明显并发症。

睑板腺癌手术切除合并睑缺损重建临床疗效的系统评价与Meta分析

目的系统评价睑板腺癌(MGC)手术切除合并睑缺损重建后的有效性及安全性。方法系统检索PubMed、Web of Science、The Cochrane Library、中国生物医学文献数据库、中国知识基础设施工程和万方数据库,检索时限均从建库至2022年4月。2位研究员独立筛选文献、提取资料并评价纳入研究的偏倚风险。使用MedCalc软件对复发率进行定量Meta分析,描述性分析其他结局。结果研究共纳入22项回顾性病例研究文献,包括了335名患者。使用不同的睑缺损重建方式均能改善眼睑的形态和功能,加权合并复发率为7.23%。74例患者报告睫毛缺损等轻微不良反应。结论MGC手术切除合并睑缺损重建后复发率低,眼睑形态功能恢复较好,不良反应轻微。

自体组织再造睑板联合颞区皮瓣修复下眼睑全层缺损

目的:总结和评价下眼睑全层缺损创伤后采用自体硬腭黏膜或耳软骨替代眼睑后层,联合眼轮匝肌蒂颞区皮瓣修复眼睑再造的临床效果。方法:对11例(11眼)下眼睑创伤后患者行自体硬腭黏膜或自体耳软骨联合眼轮匝肌蒂颞区皮瓣修复下眼睑全层缺损。11例均为重度眼睑缺损,其中眼睑75%以上全层缺损6例,50%缺损5例。结果:11眼睑术后功能及外观基本恢复正常,闭合完全,无内外翻。术后随访6个月~5年,平均3年4个月,眼睑功能及形态保持稳定,再造睑板无感染、外露及挛缩。结论:自体硬腭黏膜或耳软骨联合眼轮匝肌蒂颞区皮瓣下眼睑重建术是一种简便易行、取材方便、临床效果满意的眼睑再造术。

硬腭黏膜移植联合眉上转移皮瓣修复上睑全层缺损

目的探讨用硬腭黏膜植片替代缺损后层眼睑组织,同时转移眉上皮瓣修复缺损前层眼睑皮肤的临床疗效。方法对18例全层上眼睑缺损的患者,全部用口腔硬腭黏膜移植片替代睑板和结膜,再造后层眼睑;用眉上带蒂皮瓣转移覆盖于硬腭黏膜之上,代替缺损的眼睑皮肤,再造前层眼睑。术毕行睑缘缝合,半年后切开。术后对硬腭植片及其周围组织行病理学检查,观察植片的转归及其周围组织的情况。结果全部病例随访12个月以上,硬腭植片及转移皮瓣全部成活,无移位、感染或坏死等不良反应;眼睑外观及功能改善满意,获得良好疗效。病理检查硬腭黏膜胶原纤维仍然排列整齐,周围组织与其愈合良好。结论眉上转位皮瓣与眼睑皮肤薄厚色泽相近,由于有血液供应,易成活,且操作简单损伤小,易于被接受;硬腭黏膜植片的外形硬度与睑板近似,有良好的支撑作用,有柔软的黏膜表面,术后收缩少,取材方便,成活率高。硬腭黏膜移植联合眉上转移皮瓣修复上睑全层缺损,可以一次性修复缺损的皮肤、睑板、结膜,效果肯定,具有较高的临床价值。

异体巩膜移植替代睑板重建眼睑

目的 探讨异体巩膜移植替代睑板重建眼睑的临床效果。 方法 1986年 5月～ 2 0 0 1年 1月对 4 5例部分眼睑缺损患者 ,采用异体巩膜替代睑板行眼睑重建。其中男 31例 ,女 14例。上睑 18例 ,下睑 2 7例 ;累及上或下眼睑内眦部 9例 ,外眦部 7例。眼外伤 2 2例 ,眼睑肿瘤 2 3例。眼睑缺损不超过眼睑总长度的 1/ 2。术后观察重建眼睑的外观、功能及并发症。 结果 4 5例移植异体巩膜行眼睑重建均获成功。术后随访 11～ 38个月 ,平均 19.7个月。重建的眼睑完整 ,双侧眼睑长度及高度差值均小于 2 mm。眼睑开闭及上提功能基本正常 ,对视功能无影响。 结论 异体巩膜是替代睑板行眼睑重建的理想材料。

异种脱细胞真皮基质联合邻位皮瓣修复眼睑全层缺损的临床观察

目的观察异种脱细胞真皮基质联合邻位皮瓣I期修复眼睑恶性肿瘤切除术后眼睑全层缺损的临床疗效。方法 35例(35眼)眼睑恶性肿瘤患者,其中基底细胞癌21例,睑板腺癌13例,鳞状细胞癌1例;累及上睑者12例,累及下睑者23例。所有患者均行术中冰冻并根据冰冻结果确定切缘,肿物切除后眼睑有不同程度全层缺损。取异种脱细胞真皮基质替代结膜睑板组织,根据皮肤缺损大小做邻近滑行或转位皮瓣修补眼睑缺损。术后观察皮瓣及口腔修复膜愈合情况、有无眼睑闭合不全及睑球粘连。结果随诊半年,异种脱细胞真皮基质已完全溶解,被爬行结膜上皮覆盖,皮瓣愈合良好、无一例皮瓣坏死。其中28例患者术后恢复良好,无眼睑闭合不全及睑内、外翻。4例患者出现轻度眼睑闭合不全,均无暴露性角膜炎。3例患者出现轻度睑球粘连。结论异种脱细胞真皮基质可替代睑板结膜组织,联合邻位皮瓣治疗眼睑恶性肿瘤切除术后的眼睑全层缺损有较好的临床疗效,可减少患者因取口唇黏膜或行二次眼睑重建的痛苦。

硬腭黏膜移植修复眼睑后层缺损的疗效观察

目的观察硬腭黏膜移植修复眼睑后层(睑板结膜)缺损的效果及安全性。方法回顾性分析17例接受自体硬腭黏膜移植修复的眼睑后层缺损患者的临床及随访资料。17例患者中,男性10例(10眼),女性7例(7眼),年龄21~79岁;眼睑肿瘤切除术后一期修复10例,化学伤后眼睑内翻倒睫2例,外伤后眼睑缺损3例,结膜囊成形术佩戴义眼片后眼睑退缩2例;上睑缺损9例,下睑缺损8例。术后随访检查指标包括眼睑的形态、角膜刺激症状及裂隙灯下观察角膜上皮等。结果病例术后随访3个月至3年。随访结果显示:所有患者眼睑形态良好;接受下睑缺损修复者术后无明显不适;接受上睑缺损修复的部分患者术后早期可有眼部充血、异物感等不适症状,裂隙灯检查可见角膜上皮脱落,经局部对症治疗后症状逐渐消失。结论硬腭黏膜具有完整的黏膜上皮组织及与睑板相似的坚韧度,可有效修复眼睑后层的缺损,且对下睑有良好的支撑作用。

自体硬腭黏膜移植修复眼睑缺损的疗效观察

目的观察自体硬腭黏膜替代睑板植入在修复眼睑缺损中的应用效果。方法回顾性分析11例眼睑肿瘤切除术后患者的临床资料,切除肿瘤同时一期自体硬腭黏膜替代睑板修复眼睑后层缺损,用眶周带蒂皮瓣修复眼睑前层缺损,随访6个月至3年。结果术后所有患者眼睑形态及功能恢复良好,睑裂基本对称,眼睑活动好,无眼睑内翻倒睫及外翻等并发症出现。结论自体硬腭黏膜具有良好的形态稳定性,是一种理想的睑板替代物,应用于眼睑缺损修复效果确切。

眼睑恶性肿瘤切除术后中重度眼睑缺损的Ⅰ期修复

目的:探讨眼睑恶性肿瘤切除术后中重度眼睑缺损I期修复的手术方法和疗效。方法:2010-01/2011-10对11例11眼患者行眼睑恶性肿瘤切除术后,利用硬腭黏膜移植联合眼周皮瓣或游离皮瓣修复眼睑全层缺损行眼睑再造术。其中男3例,女8例,年龄38～77岁,眼睑全部缺损4例,1/2～2/3眼睑缺损7例。眼睑基底细胞癌6例,睑板腺癌4例,眼睑鳞状细胞癌1例。结果:术后眼睑外观及功能恢复满意,随诊6～24mo无1例肿瘤复发。结论:硬腭黏膜移植联合眼周皮瓣或游离皮瓣修复眼睑恶性肿瘤切除术后中重度眼睑全层缺损,在眼睑外形和功能上可获得满意的效果,疗效肯定,具有较高的临床价值。

颞浅动脉岛状皮瓣修复下眼睑缺损

目的:探讨颞浅动脉岛状皮瓣在修复下眼睑软组织缺损中的应用效果。方法:采用颞浅动脉岛状皮瓣修复下眼睑软组织缺损26例,观察其修复效果。结果:皮瓣全部成活,颜色、质地与眼周皮肤相近,无明显的挛缩,皮瓣感觉功能良好,睑裂闭合良好,外观满意;皮瓣供区位于发际边缘,切口隐蔽,愈合良好,无瘢痕增生。结论:应用颞浅动脉岛状皮瓣修复下眼睑软组织缺损方法简便,创伤小,切口隐蔽,修复后不仅外观效果好且下眼睑功能恢复满意,是一种修复面部眼周软组织缺损的较理想的方法。

眼轮匝肌蒂颞区皮瓣修复眼睑缺损

目的:探讨以眼轮匝肌为蒂的颞区皮瓣修复眼睑缺损的临床应用。方法:根据对耳颞部颞浅动脉系统与额部及眼眶区周围血管系统之间的交通吻合情况的解剖学研究结果,应用以眼轮匝肌为蒂的颞区皮瓣修复眼睑缺损12例。结果:12例眼睑缺损修复均取得了满意的效果,未出现并发症。结论:眼轮匝肌蒂颞区皮瓣修复眼睑缺损比局部或皮下蒂组织瓣易于移转,修复后外形满意且供区隐蔽,是修复眼睑缺损的良好选择。