State Key Laboratory of Ophthalmology, Corneoplastic Unit, Zhongshan Ophthalmic Center, Sun Yat-sen University, 54 Xianlienan Road, Guangzhou 510060, People's Republic of China.
J Trauma Acute Care Surg. 2012 Jan;72(1):288-92. doi: 10.1097/TA.0b013e31822bc0c5.
Repair of the upper lid is more difficult because of the unique anatomic requirements of the upper eyelid. The eyelid must remain pliable, allow for retraction and protraction, and also have a mucous membrane on the posterior surface. A number of procedures are available to repair large to total upper eyelid defects. These surgical techniques include lower lid switch flaps and lower lid bridge flaps. However, these procedures have several disadvantages, such as the partial or total sacrifice of the lower lid and the need for secondary correction. The authors present a new surgical technique using composite graft of acellular dermis and split-thickness buccal mucosa in the reconstruction of traumatic full-thickness upper eyelid defects to achieve satisfactory functional and esthetic results.
In this retrospective case series, eight patients requiring full-thickness upper eyelid reconstruction were evaluated. Defect size ranged from 20 mm to 28 mm horizontally and from 5 mm to 8 mm vertically. For eyelid reconstruction, the acellular dermis composite graft was sutured into the posterior lamella defect; the anterior lamella was repaired with a bipedicled orbicularis flap and a free skin graft.
Acellular dermis composite grafts achieved complete resolution of lagophthalmos and follow-up of 6 months to 31 months revealed a good outcome in all eight cases. No adverse situation of the grafts viability was encountered. Postoperative complications occurred in two patients; one had eyelid margin notching and the other had a mild ptosis.
The acellular dermis composite graft is a good match for the posterior lamella of the eyelid in terms of texture and contour. The acellular dermis composite graft technique is useful for the reconstruction of large upper eyelid defects resulting from burns or trauma because this method results in complete repair of defects without causing notable deformity.
由于上眼睑的独特解剖要求，修复上眼睑更加困难。眼睑必须保持柔韧性，允许回缩和牵引，并且在后表面还需要有一层粘膜。有许多程序可用于修复大到全层上眼睑缺损。这些手术技术包括下眼睑转移皮瓣和下眼睑桥接皮瓣。但是，这些手术存在一些缺点，例如部分或全部牺牲下眼睑以及需要二次矫正。作者提出了一种使用脱细胞真皮和颊黏膜中厚皮片复合移植物修复外伤性全层上眼睑缺损的新手术技术，以获得满意的功能和美容效果。
在这项回顾性病例系列研究中，评估了 8 名需要全层上眼睑重建的患者。缺损大小从水平方向的 20 毫米到 28 毫米不等，从垂直方向的 5 毫米到 8 毫米不等。为了进行眼睑重建，将脱细胞真皮复合移植物缝合到后层缺陷中；前层使用双蒂眼轮匝肌瓣和游离皮片修复。
脱细胞真皮复合移植物完全解决了睑裂闭合不全问题，8 例患者的随访时间为 6 个月至 31 个月，所有患者均获得良好结果。未发现移植物存活不良的不良情况。两名患者发生术后并发症；其中 1 例出现眼睑缘切迹，另 1 例出现轻度上睑下垂。
脱细胞真皮复合移植物在质地和轮廓方面非常适合眼睑的后层。脱细胞真皮复合移植物技术对于因烧伤或外伤导致的大上眼睑缺损的重建非常有用，因为这种方法可以完全修复缺损，而不会导致明显的畸形。
