Nevada Centre Eye Plastic Surgery, Reno, Nevada.
Byers Eye Institute, Stanford University School of Medicine, Palo Alto, California.
Ophthalmic Plast Reconstr Surg. 2019 Nov/Dec;35(6):569-573. doi: 10.1097/IOP.0000000000001377.
To present a novel myocutaneous flap for anterior lamellar reconstruction.
Retrospective interventional case series of consecutive patients who underwent Mohs reconstruction using the flip-back flap. Operations were performed by a single surgeon (DTT) between January 2012 and May 2016. For lower eyelid defects, an extended subciliary incision was made and a skin-muscle flap developed and suspended in the manner of lower eyelid blepharoplasty. A back-cut was used to develop a pedicle from the overlapping tissue, which was then rotated 180 degrees into the defect. A similar method was employed in an inverted manner for upper eyelid defects. Postoperative eyelid function, cosmesis, complications, and need for further interventions were assessed.
Ten patients-8 with lower and 2 with upper eyelid defects-were reconstructed using this method. Mean follow up was 18.3 ± 15.5 months with a minimum interval of 4 months. Despite the 180-degree rotation of a relatively narrow pedicle, none of the patients experienced flap necrosis. Postoperative function and cosmesis was satisfactory, with no tissue puckering, notching, or symptomatic retraction. No antimetabolite/steroid injection or surgical revision was required.
The flip-back flap expands the armamentarium of the periocular reconstructive surgeon. Its particular forte is in addressing broad and relatively shallow anterior lamellar defects where sufficient tissues are not available for transposition via a uni- or bipedicle flap. By leveraging the robust periocular vascular plexus and defying traditional guidelines governing pedicle formation and rotation, it permits creation of a local flap in cases where skin grafts or extensive Mustarde-style flaps might otherwise be required.The flip-back myocutaneous flap offers a novel alternative to skin grafting or more extensive cheek rotational flaps for reconstruction of challenging anterior lamellar defects involving the eyelids and adjacent periocular tissues.
介绍一种用于前板层重建的新型肌皮瓣。
回顾性连续病例系列研究，纳入 2012 年 1 月至 2016 年 5 月期间由同一手术医师（DTT）行翻转皮瓣 Mohs 修复的患者。对于下眼睑缺损，采用延长的睑缘下切口，以类似于下眼睑成形术的方式，形成皮肌瓣并悬吊。采用后切法从重叠组织中切取蒂部，然后将其旋转 180°进入缺损部位。对于上眼睑缺损，采用类似的反向方法。评估术后眼睑功能、美容效果、并发症和进一步干预的需求。
10 例患者（8 例下眼睑和 2 例上眼睑缺损）采用该方法进行重建。平均随访时间为 18.3±15.5 个月，最短随访时间为 4 个月。尽管旋转了相对较窄的蒂部 180°，但无患者发生皮瓣坏死。术后功能和美容效果满意，无组织皱缩、切迹或症状性回缩。无需使用抗代谢物/类固醇注射或手术修正。
翻转皮瓣扩大了眼眶重建外科医生的治疗手段。其特别适用于治疗广泛且相对较浅的前板层缺损，对于这些缺损，无法通过单蒂或双蒂皮瓣进行移位。通过利用强大的眶周血管丛，颠覆了传统的蒂部形成和旋转指导原则，它可以在需要皮片或广泛 Mustarde 式皮瓣的情况下，创建局部皮瓣。对于涉及眼睑和相邻眶周组织的具有挑战性的前板层缺损的重建，翻转肌皮瓣提供了一种替代皮片移植或更广泛的颊部旋转皮瓣的新颖选择。
