交睑皮瓣在上睑全层缺损修复中的应用  

Pedicled lower lid sharing flap for full-thickness reconstruction of the upper eyelid

作　　者：王宇翀[1] 戴海英[1] 吕川[1] 朱吉[1] 邢新[1] 薛春雨[1] 

机构地区：[1]第二军医大学附属长海医院整形外科,上海200433

出　　处：《中国美容整形外科杂志》2015年第3期153-155,共3页Chinese Journal of Aesthetic and Plastic Surgery

摘　　要：目的 探讨交睑皮瓣在修复上睑全层缺损修复中的效果.方法 手术切除上睑肿瘤后,将缺损的创面适当修剪成正三角形状,在下睑设计一倒三角形的带蒂全层下睑复合组织瓣,下睑瓣切取后旋转向上修复上睑缺损,分层缝合.下睑供区切取皮瓣后形成的继发性创面直接拉拢分层缝合,缝合困难时予下睑外眦侧设计一“Z”形皮瓣,必要时切断松解外眦韧带.下睑瓣转移修复上睑3～4.周后切断下睑瓣的蒂部,并修整上下睑缘,以恢复正常的睑缘形态.结果 皮瓣全部成活,切口Ⅰ期愈合,随访1 ～18个月,眼睑开启与闭合功能良好,形态满意,切口瘢痕不明显.结论 对于眼睑全层缺损,用交睑皮瓣进行修复简单易行,效果可靠.修复后上睑轮廓较自然,含有睫毛,并可完全恢复上睑缺损睑结膜组织的功能,不影响眼睑的开启与闭合,血运良好,愈合后肤色与周围一致.Objective To explore the clinical effect of pedicled lower lid sharing flap for full-thickness reconstruction of the upper eyelid. Methods After carcinoma was completely excised, the wound was trimmed to right triangle shape and the converse-triangle pedicled lower lid full-thickness flap was designed and harves- ted from the lower eyelid, then the flap was rotated upward to repair the defect with layering suture. The donor area of lower eyelid was closed by direct suture when possible, if it was difficult to directly close the defect, Z- flap from lateral canthus of lower eyelid with debonding of the medial canthal tendon if necessary was used to close the defect. The flap was typically divided at 3 to 4 weeks after surgery and the margin of upper eyelid was trimmed to reach the normal shape. Results The wounds of all the patients healed primarily and the flaps sur- vived without any complications. During a 1 month to 18 months follow up period, no lesion recurrence, hyper- trophic scar was noted in any of all patients. Aesthetic results in the upper eyelid were obtained for all the pa- tients. Conclusion The pedicled lower lid sharing flap is a safe and reliable method for reeonstruction of full- thickness upper eyelid defect. This procedure not only affects the function of the eyelid closure of eye protec- tion, but also directly affects the aesthetics of the structure and morphology of the face. After the second stage surgery, it has a stable eyelid margin, good blood supply and an acceptable cosmetic appearance.

关 键 词：交睑皮瓣 眼睑 缺损 睑板腺癌 

分 类 号：R739.5[医药卫生—肿瘤]