保留眼台的皮瓣法外路眼袋整复术效果观察  

Effectiveness of transcutaneous lower eyelid blepharoplasty with a skin flap reserving the pretarsal fullness

作　　者：陈建武 王玉芝 程骁宇 张黎明 李琪 陈智翔 吴燕虹 Chen Jianwu;Wang Yuzhi;Cheng Xiaoyu;Zhang Liming;Li Qi;Chen Zhixiang;Wu Yanhong(Department of Burn and Plastic Surgery,General Hospital of Southern Theater Command,PLA,Guangzhou 510010,China)

机构地区：[1]南部战区总医院烧伤整形科,广州510010

出　　处：《中华整形外科杂志》2023年第10期1088-1093,共6页Chinese Journal of Plastic Surgery

基　　金：中国博士后科学基金(2019M652964)。

摘　　要：目的:观察保留眼台的皮瓣法外路眼袋整复术效果。方法:回顾性分析2017年11月至2022年4月于南部战区总医院烧伤整形科行保留眼台的皮瓣法外路眼袋手术患者资料。术中紧贴睫毛根部切开皮肤,肌肉浅面锐性分离皮肤和眼轮匝肌,形成下睑皮瓣后在眼台沟下方对应位置部分劈开肌肉,保留睑板前眼轮匝肌和眼台沟的完整性,然后经眶隔前间隙暴露眶隔脂肪和弓状缘,对合并泪沟或中面部凹陷者常规做泪沟韧带松解和眶隔脂肪重置,眼轮匝肌切缘对位缝合,保守去皮,缝合切口。术后记录并发症情况。采用Face-Q量表进行手术决策及术后满意度评价,均为0~100分,评分越高说明越不后悔做此手术或满意度越高。根据手术前后的照片观察患者无表情和微笑时眼台的变化。结果:共纳入256例患者,其中女性233例,男性23例,年龄(43.0±10.2)岁。24例因下睑张力不足同时行外眦锚定手术,22例同期行切开重睑手术,21例同期行切提眉改善上睑松弛问题。术后随访(3.7±4.1)个月,绝大部分患者对手术效果较为满意。211例患者眼台保留良好,45例眼台消失,眼台保留率为82.4%。Face-Q满意度评分为(75.8±18.6)分,手术决策评分为(80.3±15.4)分,表示大部分患者不后悔做此手术。术后并发症包括8例眼袋残留,其中4例行二次手术切除残余眼袋脂肪;7例脂肪重置时平铺欠均匀形成隆起或不平,2例接受二次手术修复;4例血肿,均行血肿清除手术后痊愈;其余并发症包括睑外翻3例,轻微泪沟残留2例,其中1例行外翻矫正手术。结论:保留眼台的皮瓣法外路眼袋整复术手术操作简单,术后效果好,患者满意度高。ObjectiveTo evaluate the effectiveness of transcutaneous lower eyelid blepharoplasty with a skin flap reserving the pretarsal fullness.MethodsFrom November 2017 to April 2022,a retrospective analysis was performed to assess the reserving of pretarsal fullness after the transcutaneous lower blepharoplasty with a skin flap in the Department of Burn and Plastic Surgery,General Hospital of Southern Theater Command,PLA.A subciliary incision was made below the ciliary margin and a skin flap was elevated at the surface of pretarsal orbicularis.The muscle was partially split at the position of pretarsal crease,leaving the pretarsal orbicularis oculi muscle and the pretarsal crease intact.Preseptal dissection was proceeded down to the level of arcus marginalis,exposing the orbital fat pads.For patient with tear trough deformity or volume deficiency in the medial cheek,retaining ligament laxity and fat repositioning were routinely performed.The muscle wound was closed edge to edge and the excess skin was excised conservatively.Postoperative complications were recorded.Face-Q scale was used for surgical decision and postoperative satisfaction evaluation.The scores range from 0 to 100,with higher scores indicating less regret the operation or greater satisfaction.The preoperative and postoperative digital photographs were used to evaluate the change of pretarsal fullness.Results256 patients were included,of whom 233 cases were women and 23 cases were men.The age was(43.0±10.2)years.24 cases had concomitant lateral canthoplasty due to hypotonia of lower eyelid,22 had concomitant upper blepharoplasty,and 21 cases had brow lift surgery to correct upper eyelid relaxation.All patients had follow-up for(3.7±4.1)months,most patients were satisfied with the operation results.A total of 211 patients maintained a natural pretarsal fullness postoperatively,with the rate of 82.4%.The Face-Q satisfaction score was(75.8±18.6)and the surgical decision score was(80.3±15.4),indicating that most patients did not regret the operation.Posto

关 键 词：眼睑 眼台 下睑整形 经皮入路 回顾性研究 

分 类 号：R779.6[医药卫生—眼科]