Vahdani Kaveh, Siapno Debrelle Lou, Lee Jung Hye, Woo Kyung In, Kim Yoon-Duck
Bristol Eye Hospital, Bristol, UK.
Department of Ophthalmology, The Medical City, Metro Manila, Philippines.
J Craniofac Surg. 2018 Jul;29(5):1327-1331. doi: 10.1097/SCS.0000000000004464.
To report the long-term outcomes of using acellular dermal allograft (ADA) as a tarsal substitute for reconstruction of large full-thickness eyelid defects where ipsilateral or contralateral eyelid donor tissue was either not available or tarsoconjunctival transfer was insufficient to cover the full extent of the defect.
A retrospective review of a consecutive series of 10 patients between May 2003 and April 2012. Main outcome measures were anatomical and functional outcomes and complications.
The study cohort included 4 males and 6 females with a mean age of 48.1 years (range 31-64 years). Indications for reconstruction were extensive full-thickness eyelid defects (upper or lower or both) resulting from tumor excision (n = 6), traumatic eyelid defect (n = 2), electrical burn (n = 1), and eyelid necrosis (n = 1). The mean postoperative follow-up was 84.3 months (range 33-164 months). The reconstructive procedure included a variety of techniques using ADA as the posterior lamellar graft. Overall, 7 patients achieved excellent anatomical, cosmetic, and functional results. Reoperation was required in 3 patients (for postoperative upper lid retraction, upper lid entropion, and lower fornix reconstruction) despite acceptable initial results. There were no intraoperative complications, postoperative allergic or immunologic rejection associated with the use of allograft, nor any long-term sequelae.
The extensive upper and lower eyelid defects with large vertical component can be successfully repaired using ADA as a tarsal substitute. The results of our study with long-term follow-up indicate excellent functional and cosmetic outcomes with minimal morbidity.
报告在同侧或对侧眼睑供体组织不可用或睑板结膜转移不足以覆盖整个缺损范围时，使用脱细胞真皮同种异体移植物（ADA）作为睑板替代物重建大面积全层眼睑缺损的长期效果。
对2003年5月至2012年4月期间连续收治的10例患者进行回顾性研究。主要观察指标为解剖和功能结果及并发症。
研究队列包括4例男性和6例女性，平均年龄48.1岁（范围31 - 64岁）。重建的适应证为肿瘤切除（n = 6）、外伤性眼睑缺损（n = 2）、电烧伤（n = 1）和眼睑坏死（n = 1）导致的广泛全层眼睑缺损（上睑或下睑或两者均有）。术后平均随访84.3个月（范围33 - 164个月）。重建手术包括多种使用ADA作为后层移植物的技术。总体而言，7例患者获得了优异的解剖、美容和功能效果。尽管初始结果可接受，但仍有3例患者需要再次手术（分别用于术后上睑退缩、上睑内翻和下穹窿重建）。术中无并发症，术后未出现与同种异体移植物使用相关的过敏或免疫排斥反应，也无任何长期后遗症。
使用ADA作为睑板替代物可成功修复具有较大垂直成分的广泛上睑和下睑缺损。我们的长期随访研究结果表明，功能和美容效果优异，并发症最少。
