Zhai Zhen, Jin Xiaolei, Yu Lu, Yang Xiaonan, Qi Zuoliang
From the Department No. 16 of Plastic Surgery Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
Ann Plast Surg. 2019 Apr;82(4):403-406. doi: 10.1097/SAP.0000000000001817.
Auricular cartilage has been largely reported as an available substitute of defected tarsus to restore lower eyelid stability. However, undesirable results such as displacement, detachment, warping, down-gaze disturbance, and surface irregularity of the cartilage graft have been reported in previous reports, some of which require reoperations. In this study, the authors present a new technique to use strips of auricular cartilage with a local flap to restore the lower eyelid stability for a reliable eyelid support.
From 2013 to 2018, the technique was carried out on 13 patients who suffered inadequate lower eyelid support with cicatricial retraction or ectropion and incomplete eyeball coverage, which was caused by soft tissue deletion secondary to different etiologies. Two kinds of local flaps were used to reconstruct the anterior soft tissue layer, whereas the posterior layer was supported with a π-shaped auricular cartilage. The preoperative and postoperative photographs were taken. Three indexes, including the vertical distance between inferior corneal margin and inferior palpebral margin, the maximal breadth of palpebral conjunctiva caused by ectropion, and the maximal palpebral fissure breadth when eyelid is closed, were measured before and 6 months after the operation to evaluate the operative effect.
The average follow-up was 32 months (range, 6-62 months). The local flap survived in all patients. No complications were seen in any of the patients. Postoperative average of the aforementioned first 2 indexes measured at 6 months was 0 mm, whereas the preoperative one was 2.69 and 1.08 mm, respectively. Postoperative average of the third index was also far more lower than the preoperative one (0.08 vs 2.77 mm). The difference between the preoperative and postoperative evaluation of the 3 indexes was statistically significant (paired t test, P < 0.001). No further intervention was required.
The present technique using a combination of π-shaped auricular cartilage and a local flap provides a satisfying horizontal and vertical support to maintain the lower eyelid in a normal position without compromising the mobility of the lower eyelid. This technique can be used as an effective and safe method for lower eyelid support.
耳廓软骨作为修复睑板缺损以恢复下睑稳定性的替代材料已有大量报道。然而，既往报道中出现了诸如软骨移植物移位、脱离、翘曲、下视障碍及表面不平整等不良结果，其中一些需要再次手术。在本研究中，作者提出一种新技术，即使用带局部皮瓣的耳廓软骨条来恢复下睑稳定性，以获得可靠的眼睑支撑。
2013年至2018年，该技术应用于13例因不同病因导致软组织缺失而出现下睑支撑不足伴瘢痕性退缩或睑外翻以及眼球覆盖不全的患者。使用两种局部皮瓣重建前软组织层，而后层用π形耳廓软骨支撑。拍摄术前和术后照片。测量术前及术后6个月时的三个指标，包括角膜下缘与睑下缘之间的垂直距离、睑外翻导致的睑结膜最大宽度以及闭眼时的最大睑裂宽度，以评估手术效果。
平均随访32个月（范围6 - 62个月）。所有患者的局部皮瓣均存活。所有患者均未出现并发症。术后6个月上述前两个指标的平均值为0 mm，而术前分别为2.69和1.08 mm。第三个指标的术后平均值也远低于术前（0.08 vs 2.77 mm）。三个指标术前和术后评估的差异具有统计学意义（配对t检验，P < 0.001）。无需进一步干预。
目前使用π形耳廓软骨和局部皮瓣相结合的技术可提供令人满意的水平和垂直支撑，将下睑维持在正常位置，且不影响下睑的活动度。该技术可作为一种有效且安全的下睑支撑方法。
