Nguyen Cu Dinh, Hult Jenny, Sheikh Rafi, Tenland Kajsa, Dahlstrand Ulf, Lindstedt Sandra, Malmsjö Malin
Department of Clinical Sciences, Ophthalmology.
Department of Clinical Sciences, Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund Sweden.
Ophthalmic Plast Reconstr Surg. 2018 Jul/Aug;34(4):361-365. doi: 10.1097/IOP.0000000000001010.
It is well known that blood perfusion is important for the survival of skin flaps. As no study has been conducted to investigate how the blood perfusion in human eyelid skin flaps is affected by the flap length and diathermy, the present study was carried out to investigate these in patients.
Fifteen upper eyelids were dissected as part of a blepharoplastic procedure, releasing a 30-mm long piece of skin, while allowing the 5 mm wide distal part of the skin to remain attached, to mimic a skin flap (hereafter called a "skin flap"). Blood perfusion was measured before and after repeated diathermy, using laser speckle contrast imaging.
Blood perfusion decreased from the base to the tip of the flap: 5 mm from the base, the perfusion was 69%, at 10 mm it was 40%, at 15 mm it was 20%, and at 20 mm it was only 13% of baseline values. Diathermy further decreased blood perfusion (measured 15 mm from the base) to 13% after applying diathermy for the first time, to 6% after the second and to 4% after the third applications of diathermy.
Blood perfusion falls rapidly with distance from the base of skin flaps on the human eyelid, and diathermy reduces blood perfusion even further. Clinically, it may be advised that flaps with a width of 5 mm be no longer than 15 mm (i.e., a width:length ratio of 1:3), and that the use of diathermy should be carefully considered.
众所周知，血液灌注对皮瓣存活至关重要。由于尚未有研究调查人眼睑皮瓣的血液灌注如何受皮瓣长度和透热法影响，因此本研究针对患者开展，以对这些方面进行调查。
作为眼睑整形手术的一部分，解剖15只上眼睑，游离出一条30毫米长的皮肤，同时让皮肤5毫米宽的远端部分保持附着，以模拟皮瓣（以下简称“皮瓣”）。使用激光散斑对比成像技术，在反复透热前后测量血液灌注情况。
皮瓣从基部到尖端血液灌注逐渐降低：在距基部5毫米处，灌注为基线值的69%；在10毫米处为40%；在15毫米处为20%；在20毫米处仅为13%。透热法进一步降低了血液灌注（在距基部15毫米处测量），首次透热后降至13%，第二次透热后降至6%，第三次透热后降至4%。
人眼睑皮瓣的血液灌注随距基部距离的增加而迅速下降，且透热法会进一步降低血液灌注。临床上，建议宽度为5毫米的皮瓣长度不超过15毫米（即宽长比为1:3），并且应谨慎考虑使用透热法。
