硬腭黏膜移植联合眶周表浅肌肉腱膜系统皮瓣重建全层.docVIP

　　硬腭黏膜移植联合眶周表浅肌肉腱膜系统皮瓣重建全层 【摘要】 目的:探讨利用自体游离硬腭黏膜植片替代后睑组织联合眶周表浅肌肉腱膜系统(SMAS)皮瓣转移修复缺损的前层眼睑皮肤，重建因肿瘤术后或外伤所致的全层眼睑缺损的临床疗效。　方法:对16例≥眼睑全长1/2中重度全层眼睑缺损患者，全部用口腔硬腭黏膜植片替代睑板和结膜，再造后层眼睑;用眶周血供丰富的表浅肌肉腱膜系统(SMAS)皮瓣转移覆盖于硬腭黏膜上，替代缺损的眼睑皮肤肌肉层再造前层眼睑，其中10例采用眼轮匝肌单蒂皮瓣，3例为颞浅动脉皮瓣，2例为上睑皮肤轮匝肌双蒂皮瓣，1例为眉上皮瓣。手术操作中首先行硬腭黏膜移植，然后根据眼睑前层缺损的部位和范围设计眶周的SMAS转移皮瓣，手术完毕行睑缘缝合3～6mo后切开。结果:全部患者随访gt;12mo，硬腭黏膜植片及其转移皮瓣全部成活，无移位、感染和坏死等不良反应，无收缩，眼睑外观及功能改善满意。结论:硬腭黏膜联合SMAS皮瓣转移修复重建眼睑全层缺损，可以一次性修复眼睑缺损的皮肤、睑板、结膜，疗效肯定，具有较高的临床应用价值。 【关键词】 硬腭黏膜;眼睑重建;眶周表浅肌肉腱膜系统;轮匝肌带蒂皮瓣 　　AbstractAIM: To discuss the use of auto extricated hard palate mucosa grafting plates to substitute posterior layer eyelid tissue bined uscle aponeurosis system (SMAS) flap transfer for repairing defected anterior layer eyelid skin, and the clinical curative effects for fullthickness eyelid defects caused by reconstruction of injured eyes and eyelid malignant tumor.METHODS: For all 16 patients 16 eyes edium to heavily fullthickness eyelid defects larger than or equal to the full length of eyelid, oral hard palate mucosa grafting plates ucosa and substitute the defected eyelid skin and muscle layer and reconstruct anterior layer eyelids. Among them, 10 cases adopted musculus orbicularis oculi single flaps, 3 cases superficial temporal artery flaps, 2 cases upper eyelid skin orbicular muscle double flaps, 1 case oneyebroucosa grafting ed, then periorbital SMAS transfer flaps argins onths.RESULTS: For all patients onths, the hard palate mucosa grafting plates and their transfer flaps survived provements ucosa grafting plates have a similar hardness ucosa surface, no aftersurgery contraction, easy availability, and high survival rate. Periorbital SMAS flaps have similar thickness and color ple operation, and minor injuries. Reconstruction of fullthickness eyelid defect ucosa grafting bined ucosa; reconstruction of eyelids; periorbital superficial muscle aponeurosis system; musculus orbicularis oculi single flaps 　　0引言 　　眼睑肿瘤切除术后或外伤常导致眼睑部分或全部缺损。眼睑中重度全层缺损不仅影响外观，更严重的是将导致眼