Stafanous S N
Royal Hospital, Chesterfield, Sheffield, UK.
Orbit. 2007 Dec;26(4):255-62. doi: 10.1080/10717540600987513.
Full-thickness eyelid defects are conventionally reconstructed by either a Hughes flap or a Cutler-Beard bridge flap. The switch flap is an alternative method and is not very widely practiced. The author has used this method for repair of large full-thickness eyelid defects and describes her experience with the use of this technique.
Eight cases of large full-thickness eyelid defects resulting from excision of tumours such as basal cell carcinoma (bcc), squamous cell carcinoma (scc) and sebaceous gland carcinoma (sgc) were taken for repair using the switch flap technique. The technique involves switching a full-thickness flap on a pedicle to fill a defect from lower lid to upper or vice versa. The pedicle is divided in three weeks. The recipient lid is reconstructed by direct closure and the donor lid by direct closure with or without cantholysis or sliding flap, or it is left to heal by second intention. The patients were followed up frequently in the first few weeks according to need, at six months, and then every year for five years before discharge. At these visits, contour of lid, condition of wound, cornea and donor site were examined for infection, dehiscence, corneal ulcer, notching, trichiasis, and recurrence. The preoperative and postoperative photographs were also compared.
Out of the eight cases of eyelid defects, one was from squamous cell carcinoma, three were from sebaceous gland carcinoma, and four were from infiltrative basal cell carcinoma. Using the switch flap technique, the defects resulting from their excision were completely covered in all cases. The main complication was a corneal ulcer in cases 1 and 3 where the flap had crossed the central cornea. A bandage contact lens was inserted until the division of the flap. The main morbidity was the blurred vision until the flap is divided, especially in the cases of reduced vision in the other eye. At about 4-6 weeks post flap division, the recipient and donor sites have healed completely, even when the donor lid was left to heal by second intention (case 4). There was no trichiasis, notching or notable deformity, and the morbidity was minimal. A comparison between preoperative and postoperative photographs shows satisfactory results with the switch flap technique.
The author has found the switch flap technique very useful for reconstruction of large full-thickness eyelid defects resulting from tumour excision as this method results in complete repair of defects with a full-thickness flap, tarsus, lid margin and eyelashes and without causing notable deformity at the donor site. The switch flap can successfully replace the Hughes flap technique and Cutler-Beard technique for repair of large eyelid defects.
全层眼睑缺损传统上通过休斯皮瓣或卡特勒 - 比尔德桥式皮瓣进行修复。转换皮瓣是一种替代方法，但应用并不广泛。作者使用这种方法修复大面积全层眼睑缺损，并描述了她使用该技术的经验。
选取8例因切除基底细胞癌（bcc）、鳞状细胞癌（scc）和皮脂腺癌（sgc）等肿瘤导致的大面积全层眼睑缺损病例，采用转换皮瓣技术进行修复。该技术包括将带蒂的全层皮瓣转换，以填补从下眼睑到上眼睑或反之的缺损。蒂在三周后切断。受区眼睑通过直接缝合重建，供区眼睑根据情况通过直接缝合、是否进行眦松解或滑行皮瓣进行处理，或者任其二期愈合。患者在最初几周根据需要进行频繁随访，6个月时进行随访，然后在出院前每年随访5年。在这些随访中，检查眼睑轮廓、伤口情况、角膜和供区是否有感染、裂开、角膜溃疡、切迹、倒睫和复发情况。还比较了术前和术后照片。
在8例眼睑缺损病例中，1例来自鳞状细胞癌，3例来自皮脂腺癌，4例来自浸润性基底细胞癌。使用转换皮瓣技术，所有病例切除后造成的缺损均被完全覆盖。主要并发症是病例1和3中皮瓣越过中央角膜导致的角膜溃疡。在皮瓣切断前插入绷带接触镜。主要的不适是在皮瓣切断前视力模糊，尤其是在另一只眼睛视力下降的情况下。在皮瓣切断后约4 - 6周，受区和供区完全愈合，即使供区眼睑任其二期愈合（病例4）。没有倒睫、切迹或明显畸形，不适程度最小。术前和术后照片的比较显示转换皮瓣技术效果令人满意。
作者发现转换皮瓣技术对于修复因肿瘤切除导致的大面积全层眼睑缺损非常有用，因为这种方法能够用全层皮瓣、睑板、睑缘和睫毛完全修复缺损，且不会在供区造成明显畸形。转换皮瓣能够成功替代休斯皮瓣技术和卡特勒 - 比尔德技术用于修复大面积眼睑缺损。
