Mehta Milap P, Lewis Craig D, Perry Julian D
Cleveland Clinic Cole Eye Institute, Oculoplastics Division, 9500 Euclid Ave., Mailing Code 1-13, Beachwood, OH 44195, United States.
Saudi J Ophthalmol. 2011 Jan;25(1):31-6. doi: 10.1016/j.sjopt.2010.10.007. Epub 2010 Oct 13.
Eyelid reconstruction requires an understanding of normal eyelid anatomy and function. A thorough understanding of the basic anatomy, contour, and mobility of the eyelids is essential in restoring the tissue to its presurgical level. There are many different surgical options to assist in the repair of full thickness eyelid defects involving the margin. Direct wound closure depends on eyelid laxity and is often possible with smaller defects. Moderate to larger sized defects are often under undue wound tension if direct closure is attempted. We have developed a new technique for closure of eyelid defects using a transconjunctival cantholysis to release the lateral canthal tendon cruces, thereby avoiding the external incision while still allowing for eyelid mobility. Using this technique for defects 15 mm in horizontal eyelid margin length or greater, we have found positive results. Direct closure of eyelid defects represents the most straightforward technique to repair any full-thickness eyelid defect and provides maximal functional and cosmetic results. Internal cantholysis represents an excellent option for repairing smaller and even larger full thickness eyelid defects. Eyelid mobility increases by 4-10 mm, sometimes more, and allows for closure of defects larger than even 20 mm.
眼睑重建需要了解正常的眼睑解剖结构和功能。全面了解眼睑的基本解剖结构、轮廓和活动度对于将组织恢复到手术前水平至关重要。对于涉及睑缘的全层眼睑缺损的修复，有许多不同的手术选择。直接伤口闭合取决于眼睑的松弛度，较小的缺损通常可行。如果尝试直接闭合，中等至较大尺寸的缺损往往会承受过度的伤口张力。我们开发了一种新的技术来闭合眼睑缺损，即通过经结膜眦松解术来松解外眦肌腱十字交叉，从而避免外部切口，同时仍能保证眼睑的活动度。对于水平睑缘长度为15毫米或更长的缺损，使用该技术已取得了积极的效果。直接闭合眼睑缺损是修复任何全层眼睑缺损最直接的技术，能提供最佳的功能和美容效果。内眦松解术是修复较小甚至较大的全层眼睑缺损的极佳选择。眼睑活动度可增加4至10毫米，有时更多，甚至能闭合大于20毫米的缺损。
