Toft Peter B
a Department of Ophthalmology, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark.
Orbit. 2016;35(1):1-5. doi: 10.3109/01676830.2015.1078372. Epub 2015 Dec 4.
To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery.
This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50-75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft.
All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort.
Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.
回顾并展示一种一步法的结果，该方法采用游离睑板移植、肌皮蒂瓣加游离皮片移植来修复肿瘤切除术后的上睑大缺损。
这是一项回顾性病例系列研究，纳入了8例肿瘤切除术后行上睑重建的患者。水平缺损累及睑缘的50%-75%（3例）、超过75%（3例）以及超过75%并累及外眦（2例）。后层用对侧上睑睑板重建。7例患者的前层用外侧带蒂肌皮瓣重建，眉下留下的创面用游离皮片覆盖。1例眉下剩余皮肤很少的患者，前层用双蒂眼轮匝肌瓣联合游离皮片重建。
所有患者均愈合良好，无坏死，未出现兔眼，美容效果尚可，且无需使用润滑剂。1例患者因角膜糜烂在3周内需佩戴隐形眼镜。1例患者在切除术后3个月仍需佩戴隐形眼镜以避免眼部不适。
游离睑板移植、外侧带蒂肌皮瓣联合游离皮片移植可用于修复上睑大缺损。多数情况下可能无需进行两步手术。
