应用眼轮匝肌蒂颞部皮瓣矫正睑外翻
摘要
目的：睑外翻是整形外科常见的眼部畸形，传统的修复方法虽然很多，但效果均非尽如人意。1991年Youshimura等首次报告了以眼轮匝肌为蒂的颞部皮瓣修复上睑缺损，受其启发，我们采用以眼轮匝肌为蒂的颞部皮瓣修复睑外翻。本文的目的是探讨应用眼轮匝肌蒂颞部岛状皮瓣修复睑外翻的具体方法及其效果。
方法：2003-2004年设计采用以眼轮匝肌为蒂的颞区皮瓣，矫正瘢痕性睑外翻12例。术中沿睑缘做切口松解瘢痕挛缩，依创面大小在同侧颞部设计皮瓣，长宽比例不超过6：1，于颞浅筋膜浅面剥离，至近端于眼轮匝肌下剥离，以部分眼轮匝肌束为蒂，皮瓣旋转180°转移修复眼睑瘢痕松解后创面。
结果：术后12例皮瓣完全成活，随访半年，睑外翻无复发，皮瓣颜色、质地与受区匹配良好，供区瘢痕不明显，外观满意。
结论：眼轮匝肌蒂颞部岛状皮瓣血供可靠，成活的长宽比大大超过常规随意型皮瓣，修复睑外翻可取得功能与外观双重修复的满意结果。
Objective:
Eyelid ectropion is a commom malformation in plastic surgery.The traditional treatments are not perfect. The temporal flap pedicled with Orbicularis oculi muscle was first reported by Youshimura in 1991.To probe into the methods and effects of eyelid ectropion repaired by temporal flap pedicled with Orbicularis oculi muscle .
Methods:
From 2003 to 2004,12 cases with cicatricial eyelid ectropion were repaired by temporal flap pedicled with Orbicularis oculi muscle. Through the eyelid edge incison,scar contracture was relaxed.According to the area of the deficiency, the flap was designed in the temporal area.The flap transferred to cover eyelid defect with a 180-degree rotation.
Results:
All the flaps were survived after operation.seven cases were followed up half a year,no one ectropion recurred and the scar at the donor site was neglected.
Conclusion:
The blood supply of temporal flap pedicled with orbicularis oculi muscle is reliable. The operation get a satisfactory outcome ,both in function and appearance.
方法：2003-2004年设计采用以眼轮匝肌为蒂的颞区皮瓣，矫正瘢痕性睑外翻12例。术中沿睑缘做切口松解瘢痕挛缩，依创面大小在同侧颞部设计皮瓣，长宽比例不超过6：1，于颞浅筋膜浅面剥离，至近端于眼轮匝肌下剥离，以部分眼轮匝肌束为蒂，皮瓣旋转180°转移修复眼睑瘢痕松解后创面。
结果：术后12例皮瓣完全成活，随访半年，睑外翻无复发，皮瓣颜色、质地与受区匹配良好，供区瘢痕不明显，外观满意。
结论：眼轮匝肌蒂颞部岛状皮瓣血供可靠，成活的长宽比大大超过常规随意型皮瓣，修复睑外翻可取得功能与外观双重修复的满意结果。
Objective:
Eyelid ectropion is a commom malformation in plastic surgery.The traditional treatments are not perfect. The temporal flap pedicled with Orbicularis oculi muscle was first reported by Youshimura in 1991.To probe into the methods and effects of eyelid ectropion repaired by temporal flap pedicled with Orbicularis oculi muscle .
Methods:
From 2003 to 2004,12 cases with cicatricial eyelid ectropion were repaired by temporal flap pedicled with Orbicularis oculi muscle. Through the eyelid edge incison,scar contracture was relaxed.According to the area of the deficiency, the flap was designed in the temporal area.The flap transferred to cover eyelid defect with a 180-degree rotation.
Results:
All the flaps were survived after operation.seven cases were followed up half a year,no one ectropion recurred and the scar at the donor site was neglected.
Conclusion:
The blood supply of temporal flap pedicled with orbicularis oculi muscle is reliable. The operation get a satisfactory outcome ,both in function and appearance.
引文
1. Yoshimura Y, Nakajima T, Yoneda K. Reconstruction of the entire upper eyelid area with a subcutaneous pedicle flap based on the orbicularis oculi muscle[J].Plast.Reconstr.Surg,1991,88:136.
2．陈光宇，周刚，李罡．眼轮匝肌蒂颞区皮瓣修复面部缺损[J] 中华整形烧伤外科杂志，1998，14：130-132
3. Carraway, J.H. Cary.G.M. The prevention and treatment of lower lid ectropion following blepharoplasty.[J] Plast.Reconstr.Surg, 1990, 85: 971-981.
4．杨彪炳，蔡霞，唐胜建，等，眼轮匝肌蒂颞区皮瓣解剖学研究．[J] 中华医学美学美容杂志，2001，7：188。
5．陆文鹏．颞部真皮下血管网皮瓣修复下睑外翻畸形[J] 实用美容整形外科杂志 2001，12(2)：90
6．李东，谢宏彬，李健宁．眼轮匝肌肌皮瓣修复瘢痕性睑外翻[J] 中华医学美学美容杂志 2003，9：21-23
7．司徒朴，侯文明，熊明根，等。颞额部皮瓣修复眼睑外翻的体会[J] 中华整形烧伤外科杂志，1995，11：290-291
8. Mcgregor IA,Morgan G. Axial and random pattern flaps[J] Br Plast Surg, 1973,26:202-213
9．杨彪炳，蔡霞，唐胜建，等，逆行颧眶动脉蒂皮瓣的应用解剖学研究[J] 中国临床解剖学杂志，2001，19：321-322
10．张世民，徐达传，顾玉东，等，链型皮瓣的血管基础及临床意义．[J] 中国临床解剖学杂志 2004，22(1)：13
1. Mcgregor IA,Morgan G. Axial and random pattern flaps[J]. Br Plast Surg, 1973,26:202-213.
2．张世民，徐达传，顾玉东，等．链型皮瓣的血管基础及临床意义[J]．中国临床解剖学杂志 2004，22(1)：13．
3．侯春林，张世民．筋膜皮瓣与筋膜蒂组织瓣[M]．上海：上海科学技术出版社，2000，231～245．
4．钟世镇，徐达传．肢体血供规律与组织瓣设计关系[J] 临床解剖学杂志，1996，14(3)：161～163．
5．钟世镇，徐达传，丁自海．显微外科临床解剖学[M]．山东科技出版社，2001，32～40．
6．司徒朴，侯文明，熊明根．颞额部皮瓣修复眼睑外翻的体会[J]．中华整形烧伤外科杂志，11(4)：290-291．
7．邢新，杨志勇．局部皮瓣在创面修复中的应用[J]．中国实用美容整形外科杂志，16(4)：253-256
8. Daniel Marchac. Surgery of basal gellgareinoma of the face[M] Printer in Germany:Springer-verlag Berlin Heidelberg, 1988,22.
9．郭恩覃．现代整形外科学[M]．北京：人民军医出版社，2000．128．
10. Pontes L,Ribeiro M,Vrancks J,et al.The new bilaterally pedicled V-Y advancement flap for face reconstruction[J].plast Reconstr Surg,2002,109(6):1870.
11. Carvalho LM,Ramos RR, Santos ID,et al.V-Y advancement flap for the reconstruction of partial and full thickness defects of the upper lip[J].Scand J Plant Reconstr Surg Hand Surg,2002,36( 1 ):28.
12. Ito S.Suzuki,Park,T.Kawazoe,Y.Saso,et al.Eyelid reconstruction using a hard palate mucoperiosteal graf combined with a V-Y subcutaneous pedicled flap[J].Br J Plast Surg,2001,54:106.
13．丰德宽，陈鹏云，冯殿生，等．皮下蒂V-Y皮瓣的临床应用[J]．中华整形烧伤外科杂志，1991，7(1)：39．
14. Emmett AJ.The closure of defects by using adjacent triangular flaps with subcutaneous pedicles[J].Plast Reconstr Surg, 1977,59(1):45.
15．陈江萍，邢新，杨志勇．“风筝”皮下蒂皮瓣在面部皮肤缺损中的应用[J]．中国实用美容整形外科杂志．16(2)，77-79．
16. Lister GD,Gibson T.Closure of rhomboid skin defects:the flaps of Limberg andDufourmental[J].Br J Plast Surg, 1972,25(3):300.
17．邢新，杨志勇，局部皮瓣在创面修复中的应用[J] 中国实用美容整形外科杂志，16(4)：253-256．
18．李军辉，邢新，欧阳天祥等，皮下组织蒂的改良菱形皮瓣在面部皮肤缺损修复中的应用[J] 中国实用美容整形外科杂志，2005，10：271-272．
19. Yoshimura Y, Nakajima T, Yoneda K. Reconstruction of the entire upper eyelid area with a subcutaneous pedicle flap based on the orbicularis oculimuscle[J].Plast Reconstr Surg,1991,88:136.
20．杨彪炳 蔡霞 唐胜建．眼轮匝肌蒂颞区皮瓣解剖学研究[J] 中华医学美学美容杂志，7(4)：188-190．
21．张锋 陈光宇 范飞，眼轮匝肌蒂颞区皮瓣的临床应用[J]中华外科杂志，40(7)556．
22. Mitz V, Pevronie M.The superficial masculoaponeurotic system(SMAS) in the periotic and cheek area.[J]Plast Reconstr Surg, 1976,58:80-83.
23. Thallar SR,Patterson H. The submuscular aponeurotic system(SMAS):a histologic and comparative anatomy evaluation.[J]Plast Reconstr Surg, 1990,86:690-695.
24．王晓军，陈美云，徐世荣，等．多层综合除皱术[J]．中华整形烧伤外科杂志，1998，14：173 175．
25．王晓军 刘志飞 曾昂．应用SMAS蒂岛状皮瓣修复面部皮肤缺损[J]．中华整形外科杂志，21(3)：216-217．
26．王晓军，刘志飞，赵玉明．应用SMAS-颈阔肌蒂肌皮瓣修复唇颊部皮肤及软组织缺损[J]中国实用美容整形外科杂志，16(10)：280-281．
27. Marcel Derker,surgical techniques for cutaneous scars revison,[M]NEW YORK Marcel Derker,2000,25-37.
2．陈光宇，周刚，李罡．眼轮匝肌蒂颞区皮瓣修复面部缺损[J] 中华整形烧伤外科杂志，1998，14：130-132
3. Carraway, J.H. Cary.G.M. The prevention and treatment of lower lid ectropion following blepharoplasty.[J] Plast.Reconstr.Surg, 1990, 85: 971-981.
4．杨彪炳，蔡霞，唐胜建，等，眼轮匝肌蒂颞区皮瓣解剖学研究．[J] 中华医学美学美容杂志，2001，7：188。
5．陆文鹏．颞部真皮下血管网皮瓣修复下睑外翻畸形[J] 实用美容整形外科杂志 2001，12(2)：90
6．李东，谢宏彬，李健宁．眼轮匝肌肌皮瓣修复瘢痕性睑外翻[J] 中华医学美学美容杂志 2003，9：21-23
7．司徒朴，侯文明，熊明根，等。颞额部皮瓣修复眼睑外翻的体会[J] 中华整形烧伤外科杂志，1995，11：290-291
8. Mcgregor IA,Morgan G. Axial and random pattern flaps[J] Br Plast Surg, 1973,26:202-213
9．杨彪炳，蔡霞，唐胜建，等，逆行颧眶动脉蒂皮瓣的应用解剖学研究[J] 中国临床解剖学杂志，2001，19：321-322
10．张世民，徐达传，顾玉东，等，链型皮瓣的血管基础及临床意义．[J] 中国临床解剖学杂志 2004，22(1)：13
1. Mcgregor IA,Morgan G. Axial and random pattern flaps[J]. Br Plast Surg, 1973,26:202-213.
2．张世民，徐达传，顾玉东，等．链型皮瓣的血管基础及临床意义[J]．中国临床解剖学杂志 2004，22(1)：13．
3．侯春林，张世民．筋膜皮瓣与筋膜蒂组织瓣[M]．上海：上海科学技术出版社，2000，231～245．
4．钟世镇，徐达传．肢体血供规律与组织瓣设计关系[J] 临床解剖学杂志，1996，14(3)：161～163．
5．钟世镇，徐达传，丁自海．显微外科临床解剖学[M]．山东科技出版社，2001，32～40．
6．司徒朴，侯文明，熊明根．颞额部皮瓣修复眼睑外翻的体会[J]．中华整形烧伤外科杂志，11(4)：290-291．
7．邢新，杨志勇．局部皮瓣在创面修复中的应用[J]．中国实用美容整形外科杂志，16(4)：253-256
8. Daniel Marchac. Surgery of basal gellgareinoma of the face[M] Printer in Germany:Springer-verlag Berlin Heidelberg, 1988,22.
9．郭恩覃．现代整形外科学[M]．北京：人民军医出版社，2000．128．
10. Pontes L,Ribeiro M,Vrancks J,et al.The new bilaterally pedicled V-Y advancement flap for face reconstruction[J].plast Reconstr Surg,2002,109(6):1870.
11. Carvalho LM,Ramos RR, Santos ID,et al.V-Y advancement flap for the reconstruction of partial and full thickness defects of the upper lip[J].Scand J Plant Reconstr Surg Hand Surg,2002,36( 1 ):28.
12. Ito S.Suzuki,Park,T.Kawazoe,Y.Saso,et al.Eyelid reconstruction using a hard palate mucoperiosteal graf combined with a V-Y subcutaneous pedicled flap[J].Br J Plast Surg,2001,54:106.
13．丰德宽，陈鹏云，冯殿生，等．皮下蒂V-Y皮瓣的临床应用[J]．中华整形烧伤外科杂志，1991，7(1)：39．
14. Emmett AJ.The closure of defects by using adjacent triangular flaps with subcutaneous pedicles[J].Plast Reconstr Surg, 1977,59(1):45.
15．陈江萍，邢新，杨志勇．“风筝”皮下蒂皮瓣在面部皮肤缺损中的应用[J]．中国实用美容整形外科杂志．16(2)，77-79．
16. Lister GD,Gibson T.Closure of rhomboid skin defects:the flaps of Limberg andDufourmental[J].Br J Plast Surg, 1972,25(3):300.
17．邢新，杨志勇，局部皮瓣在创面修复中的应用[J] 中国实用美容整形外科杂志，16(4)：253-256．
18．李军辉，邢新，欧阳天祥等，皮下组织蒂的改良菱形皮瓣在面部皮肤缺损修复中的应用[J] 中国实用美容整形外科杂志，2005，10：271-272．
19. Yoshimura Y, Nakajima T, Yoneda K. Reconstruction of the entire upper eyelid area with a subcutaneous pedicle flap based on the orbicularis oculimuscle[J].Plast Reconstr Surg,1991,88:136.
20．杨彪炳 蔡霞 唐胜建．眼轮匝肌蒂颞区皮瓣解剖学研究[J] 中华医学美学美容杂志，7(4)：188-190．
21．张锋 陈光宇 范飞，眼轮匝肌蒂颞区皮瓣的临床应用[J]中华外科杂志，40(7)556．
22. Mitz V, Pevronie M.The superficial masculoaponeurotic system(SMAS) in the periotic and cheek area.[J]Plast Reconstr Surg, 1976,58:80-83.
23. Thallar SR,Patterson H. The submuscular aponeurotic system(SMAS):a histologic and comparative anatomy evaluation.[J]Plast Reconstr Surg, 1990,86:690-695.
24．王晓军，陈美云，徐世荣，等．多层综合除皱术[J]．中华整形烧伤外科杂志，1998，14：173 175．
25．王晓军 刘志飞 曾昂．应用SMAS蒂岛状皮瓣修复面部皮肤缺损[J]．中华整形外科杂志，21(3)：216-217．
26．王晓军，刘志飞，赵玉明．应用SMAS-颈阔肌蒂肌皮瓣修复唇颊部皮肤及软组织缺损[J]中国实用美容整形外科杂志，16(10)：280-281．
27. Marcel Derker,surgical techniques for cutaneous scars revison,[M]NEW YORK Marcel Derker,2000,25-37.