Wu Shun, Guo Ke, Xiao Peng, Sun Jiaming
Department of Plastic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, 1277 Jiefang Avenue, Wuhan, 430022, China.
Aesthetic Plast Surg. 2018 Feb;42(1):226-233. doi: 10.1007/s00266-017-1001-1. Epub 2017 Nov 3.
Epicanthoplasty combined with double-eyelid blepharoplasty is one of the most popular cosmetic procedures in Asians. However, the postoperative medial canthal scar is a concerned issue. Here the authors adopted some modifications of Z-epicanthoplasty to minimize the canthal scar.
Modifications of Z-epicanthoplasty were mainly in three aspects. First, supratarsal creases were created before epicanthoplasty to prevent the impact of tension variation on epicanthal incisions, caused by elevating and tightening of the upper eyelid skin. Second, one triangle flap was determined according to the transposition of another one in Z-plasty, and hence, it can be guaranteed that the incisions were closed free of tension with more accuracy and less injury to surrounding tissues. Third, linear scar contracture was avoided by adopting discontinuous incisions, and the resulting skin bulge was eliminated by making an additional stitch to anchor the pretarsal skin on the tarsal plate. The follow-up interval was 1 month to 2 years, with a median of 6.5 months.
From January 2012 to December 2015, 237 female and 4 male patients received the surgery. Except five (2.07%) patients, who were not satisfied with the color of incision scars in medial canthal area, none complained about scars 6 months after surgery. The appearance of the supratarsal crease was natural, and the medial canthal scar was inconspicuous in close observation at 2 years.
The modifications of Z-epicanthoplasty are safe and effective. It is potentially helpful to minimize postoperative medial canthal scars.
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内眦赘皮矫正术联合双眼皮成形术是亚洲人最流行的美容手术之一。然而，术后内眦瘢痕是一个令人关注的问题。在此，作者采用了一些改良的Z形内眦赘皮矫正术以尽量减少内眦瘢痕。
Z形内眦赘皮矫正术的改良主要在三个方面。第一，在内眦赘皮矫正术前形成上睑皱襞，以防止上睑皮肤提升和收紧导致的张力变化对内眦切口产生影响。第二，根据Z成形术中另一个三角瓣的移位确定一个三角瓣，从而可以保证切口在无张力的情况下更准确地闭合，对周围组织的损伤更小。第三，采用间断切口避免线性瘢痕挛缩，并通过额外缝合将睑前皮肤固定在睑板上来消除由此产生的皮肤隆起。随访时间为1个月至2年，中位时间为6.5个月。
2012年1月至2015年12月，237例女性和4例男性患者接受了手术。除5例（2.07%）患者对内眦区域切口瘢痕颜色不满意外，术后6个月无患者抱怨瘢痕问题。上睑皱襞外观自然，2年时近距离观察内眦瘢痕不明显。
改良的Z形内眦赘皮矫正术安全有效。它可能有助于尽量减少术后内眦瘢痕。
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