矩形推进皮瓣在睑缘眼睑缺损修复中应用.docVIP

矩形推进皮瓣在睑缘眼睑缺损修复中应用[摘要]目的：探讨应用矩形推进皮瓣修复睑缘眼睑缺损的效果。方法：对36例睑缘肿物切除的眼睑缺损患者，采用矩形或双矩形推进皮瓣修复眼睑前层缺损。眼睑后层睑板缺损小于5mm者，采用直接缝合法；睑板缺损大于5mm者,采用睑板睑结膜瓣移行法。结果：36例患者皮瓣全部成活，切口Ⅰ期愈合，手术瘢痕轻微?睫毛无缺失?无倒睫?睑缘圆滑无切迹畸形。结论：在合并睑缘缺损的眼睑缺损修复中使用矩形推进皮瓣，具有良好的美容效果。 [关键词]推进皮瓣；眼睑；重建 [中图分类号]R622 [文献标识码]A[文章编号]1008-6455（2007）11-1516-02 Clinical application of rectangular advacement flaps repair eyelid defects accompanying with palpebra edge defects ZHANGXu-xia (Department of Plastic andAesthetic Surgery,Foshan Second People’s Hospital528000,Guangdong,China) Abstract:ObjectiveTo evaluate the result of using rectangular advacement flaps for repairing the eyelid defects at the edges of palpebra.MethodsWe have used rectangular or double rectangular advacement flaps to repair the defects of theantieror margin of eyelid in 36 cases.To repair the posterior margin defects ,when the defects of thetarsal plates were shorter than 5mm,the tarsal plates were closed directly , longer than 5mm ,sliding tarsal palpebral conjunctive flaps were to be used.ResultsIn 36 cases all of the flaps were survived with primary healing, slight scar, no absence of eyelashes, no notch deformity at the edge of palpebra, no trichiasis. Conclusion Using rectangle advacement flap to repair the defect of eyelid at the eldge of eyelid has a good cosmetic results. Key words: advacement flap; eyelid; recontruction 眼睑缘的肿物切除后，常造成睫毛、睑板及皮肤肌肉的缺损，眼睑的特殊结构及在面部所处的重要地位，使眼睑缺损的修复要求高。修复不当易造成眼睑变形，如重睑线变形?假性上睑下垂、倒睫、睑缘切迹畸形?睫毛缺失等。自2003年1月至2007年1月，对36例睑缘肿物切除后的眼睑缺损，采用矩形推进皮瓣修复眼睑前层缺损，直接缝合法或睑板睑结膜瓣移行法修复眼睑后层缺损，收到良好的效果。 1临床资料 自2003年1月至2007年1月行眼睑缘肿物切除的患者36例，其中男15例，女21例。左眼24例，右眼12例。年龄最大75岁，最小26岁。色素痣25 例，疣8 例，炎性肉芽肿3例。肿物最大11mm×8mm×5mm，最小7mm×5mm×4mm。 2手术方法 2.1 肿物未侵及睑板 2.1.1肿物外1～2mm切除肿物,创面修整成矩形。 2.1.2睑缘灰线处将眼睑分成前后两层，即行Hughes睑劈开术，并做矩形皮瓣修复缺损。又分为以下几种情况：①肿物在眼睑中部，可向鼻侧或颞侧作矩形皮瓣，肿物较大者可作双侧的矩形推进皮瓣；②肿物接近泪小点者，术中以泪道冲洗针头探拭泪道，保护泪小点及泪小管，向颞侧作矩形推进皮瓣；③若肿物过大，颞侧皮瓣可越过外眦向颞部延伸，鼻侧皮瓣不可超越泪小点。 2.2肿物侵及睑板 2.2.1侵及睑板小于5mm者，睑板作三角形切除后，直接拉拢缝合。 2.2.2侵及睑板大于5mm者，睑板做矩形切除后