外伤性眼睑缺损的急诊处理  

Management of acute traumatic eyelid defects

作　　者：秦毅[1] 陈涛[1] 李冬梅[1] 

机构地区：[1]首都医科大学附属北京同仁医院北京同仁医院眼科中心眼科学与视觉科学重点实验室,北京100022

出　　处：《中华眼外伤职业眼病杂志》2013年第1期17-21,共5页Chinese Journal of Ocular Trauma and Occupational Eye Disease

摘　　要：目的探讨急诊眼睑缺损的临床特点、处理要点及手术技巧。方法外伤性眼睑缺损34例，创面均无法直接拉拢缝合。浅层缺损〈2／3眼睑全长者，采取邻近皮瓣修复；缺损〉2／3眼睑全长者，选用耳后或上臂内侧的游离皮片修复，行睑缘粘连；全层眼睑缺损〈1／2眼睑长度者，松解外眦后拉拢睑板分层缝合；缺损〉1／2眼睑长度者，滑行结膜瓣修复缺失的结膜、使用异体巩膜替代睑板、转位皮瓣修复浅层组织并行睑缘粘连。如外伤较重，全身病情不允许一期修复者，彻底清创后碘仿纱布覆盖创面，等待二期整复。结果浅层组织缺损共25例，19例应用皮瓣修复，恢复良好；6例行游离皮片移植。全层上眼睑缺损9例，5例缺损小于1／2眼睑长度，外眦松解后拉拢睑板分层缝合，恢复良好；2例为睑板及皮肤组织全部缺失，采用滑行结膜瓣、异体巩膜及转位皮瓣修复，并行睑缘粘连。另2例全层眼睑组织缺损者，因伤情较重，以碘仿纱布覆盖伤口，伤口干燥无感染，分别在伤后7d和20d行眼睑重建术。结论仔细清创、灵活设计手术方案、耐心缝合破碎组织，是急诊外伤性眼睑缺损手术成功的关键；皮瓣是浅层组织修复的首选方法；正确合理的过渡处理，能为个别无法一期手术的患者提供良好的二期整复条件。Objective To investigate the clinical characteristics, operation techniques and keys for acute traumatic eyelid defects. Method 34 cases with traumatic eyelid defects, in which none of the wounds could be repaired by direct closure. In anterior lamella eyelid defects, moderate defects （less than 2/3 in- volvement） were repaired by advancement, rotation or transposition flaps, and skin grafts from posterior au- ricular skin and medial upper arm were used for large defects （ more than 2/3 ） followed by tarsorrhaphies af- terwards. Moderate full-thickness eyelid defects （ 〈 1/2 involvement） were repaired by semicircular flaps with lateral eantholysis, while extensive full-thickness defects （ 〉 1/2 involvement） were repaired layer by layer through skin flaps, preserved selera （replacing the tarsal plate） and advanced conjunctival flaps fol- lowed by tarsorrhaphies afterwards. For those special patients with heavy systemic problem or trauma, after copious irrigation washes and through debridement the wound were covered by iodoform gauzes for secondary repair. Result 19 cases of the 25 cases with anterior lamella upper eyelid defects were repaired by various skin flaps, and recovered well. The other 6 cases repaired by skin grafts. There were 9 cases of full-thick- ness eyelid defects, 5 cases with 〈 1/2 involvement repaired by semicircular flaps with lateral cantholysis and recovered well, and 2 cases were repaired layer by layer through skin flaps, preserved sclera and ad- vanced conjunctival flaps. In the remainder 2 cases, covered by iodoform gauzes there was no infection in the wound, and the eyelid were reconstructed 7 and 20 days later respectively. Conclusion The keys to suc- cessful suYgery for traumatic eyelid defect are careful debridement, flexible operation skills and meticulous suture of the fragmentized tissues. Additionally, flap is always the first choice to ensure the best contour and optimal function. The special patients who couldn＇ t endure emergent surgery need reasonab

关 键 词：眼睑缺损 外伤性 重建 

分 类 号：R77[医药卫生—眼科]