Whitaker L A, Yaremchuk M J
Division of Plastic Surgery, Hospital of the University of Pennsylvania, Philadelphia 19104.
Ann Plast Surg. 1990 Dec;25(6):440-9. doi: 10.1097/00000637-199012000-00003.
A retrospective analysis of our experience, techniques, and concepts for the secondary reconstruction of orbital injuries to 78 patients over a 15-year period is presented. Secondary orbital reconstruction has the following four basic steps: (1) freeing of the overlying soft tissues by extensive subperiosteal dissection; (2) skeletal reconstruction, usually with onlay bone grafting and contour osteoplasty; (3) restoration of palpebral shape and position by medial and lateral canthopexy; and (4) soft-tissue refinement. Reconstruction required an average of at least two operations. In this series, there were no mortalities, three infections, and no reoperations for bleeding. Thirty patients required a second operation to an area previously addressed reflecting inadequacies in technique, the unpredictability of bone grafts, and soft-tissue scarring. Distortion of the skeletal infrastructure is most amenable to secondary reconstruction. Soft-tissue distortions that accompany bone malposition are less well corrected. Soft-tissue contraction is the limiting factor in successful reconstruction dictating separate movement of the overlying soft tissues and ligaments, their overcorrection, and subsequent revisional surgery. Secondary orbital reconstruction, although providing significant improvement, usually fails to restore the preinjury appearance, and usually falls short of properly performed acute reconstruction.
本文对15年间78例眼眶损伤二期重建的经验、技术和理念进行了回顾性分析。眼眶二期重建有以下四个基本步骤：（1）通过广泛的骨膜下剥离松解覆盖的软组织；（2）骨骼重建，通常采用贴附植骨和轮廓整形术；（3）通过内外眦固定术恢复睑裂形状和位置；（4）软组织精细化处理。重建平均至少需要两次手术。在本系列中，无死亡病例，3例感染，无因出血再次手术的情况。30例患者需要对先前处理过的区域进行二次手术，这反映了技术的不足、骨移植的不可预测性和软组织瘢痕形成。骨骼结构的畸形最适合二期重建。伴随骨错位的软组织畸形矫正效果较差。软组织收缩是成功重建的限制因素，这决定了覆盖的软组织和韧带要单独移动、过度矫正以及随后的修复手术。眼眶二期重建虽然能带来显著改善，但通常无法恢复伤前外观，且通常不及正确实施的急性重建效果。
