David Geffen School of Medicine at University of California Los Angeles, Division of Plastic and Reconstructive Surgery, Los Angeles, CA 90095-6960, USA.
J Plast Reconstr Aesthet Surg. 2012 Jan;65(1):48-53. doi: 10.1016/j.bjps.2011.07.029. Epub 2011 Aug 27.
Lower eyelid scaring and malposition following violation of all three lamellae pose a significant ophthalmologic reconstructive challenge. The purpose of our study was to document a staged approach for this problem using: 1) transconjunctival scar release followed by palatal graft below the tarsal plate and subciliary scar release followed by full-thickness skin graft superficial to the tarsal plate and 2) subsequent autologous fat grafting to the lower eyelid.
Cadaveric anatomic dissections were performed. Post-traumatic and post-surgical lower eyelid deformities requiring reconstruction were reviewed and outcome assessment was based on symptomatic improvement, perioperative complications, reoperations and long-term follow-up (> 1 year).
Cadaver dissections demonstrated consistent lower eyelid tarsal plate and lamellar anatomy for the use of palatal graft and skin grafting. Clinically, 75% cases resulted from full thickness traumatic laceration of the lower eyelid or malar region and 25% of cases occurred after transconjunctival incisions were made for zygomatic maxillary repositioning following partial lower eyelid laceration. Preoperative symptoms of: epiphora, tearing, redness, blurry vision and dryness improved in all patients and complete resolution was seen in 63% of patients. Thirty-seven percent of patients had complications: Redundancy of palatal graft, Partial FTSG loss, cellulitis after fat transfer.
We describe an approach for the scarred and displaced lower eyelid following injury to all three lamellae that provided symptomatic improvement after lower lid scar tissue release, lengthening of the contracted septum, support of the posterior lamellae with a palatal graft and a replacement of anterior lamella with full thickness skin graft.
下眼睑瘢痕和错位，在违反所有三眼睑层后，构成了重大的眼科重建挑战。我们研究的目的是记录使用以下方法治疗该问题的分期方法：1）经结膜瘢痕松解术，然后在睑板下方进行腭移植物；下睑板浅层的下睑板和全层皮肤移植物切除，以及 2）随后在下眼睑进行自体脂肪移植。
进行了尸体解剖分析。回顾了需要重建的创伤后和手术后下眼睑畸形，并根据症状改善、围手术期并发症、再次手术和长期随访（>1 年）进行了结果评估。
尸体解剖显示，下眼睑睑板和板层结构一致，可用于腭移植物和皮肤移植。临床上，75%的病例是由于下眼睑或颧骨区域的全层创伤性撕裂伤，25%的病例是在部分下眼睑撕裂伤后，为了重新定位颧骨上颌骨而进行经结膜切口后发生的。所有患者的术前症状：溢泪、流泪、红肿、视力模糊和干燥均得到改善，63%的患者完全缓解。37%的患者出现并发症：腭移植物冗余、部分 FTSG 丧失、脂肪转移后蜂窝织炎。
我们描述了一种治疗所有三眼睑层受伤后瘢痕和错位的下眼睑的方法，该方法通过下眼睑瘢痕组织松解、缩短收缩的中隔、腭移植物支撑后板层以及全层皮肤移植物替代前板层，提供了症状改善。
