Abe Yoshiro, Ishida Soushi, Mineda Kazuhide, Yamashita Yutaro, Yoshimoto Sho, Hashimoto Ichiro
From the Department of Plastic and Reconstructive Surgery, Tokushima University Graduate School of Medical Science, Tokushima, Japan.
Ann Plast Surg. 2020 Jun;84(6):700-704. doi: 10.1097/SAP.0000000000002080.
Lower eyelid reconstruction is challenging because of the risk of severe postreconstruction deformities of the lower eyelid, such as drooping, entropion, and ectropion. However, the risk factors for these postreconstruction deformities are unclear. The present study aimed to quantify the drooping deformity of the lower eyelid after reconstruction using a cheek rotation flap and to identify risk factors associated with postreconstruction deformities.
Our study group included 28 patients who underwent full-thickness lower eyelid reconstruction using a cheek rotation flap for anterior lamella reconstruction. We developed the drooping index to classify postreconstruction outcomes as good (index <1.2), fair (index between 1.2 and 1.5), and poor (index >1.5). We identified risk factors for a drooping deformity using univariate analyses (Mann-Whitney U or Spearman rank correlation, depending on data distribution).
Overall, the drooping index ranged between 1.0 and 2.11, with an average value of 1.3. A good outcome was obtained in 11, a fair outcome in 12, and a poor outcome in 5 patients. Clinically severe ectropion was observed in five of the 17 patients in the fair and poor outcome groups, with four of these patients requiring revision surgery. Risk factors for postreconstruction drooping deformity included medial location of the tumor, resection involving more than 50% of the horizontal width of the lower eyelid, and dissection of subcutaneous tissue of the cheek extending below the zygomatic arch.
A cheek rotation flap provides satisfactory outcomes for full-thickness reconstruction of the lower eyelid. Extension of dissection of subcutaneous tissue of the cheek below the zygomatic arch increases the risk of postsurgical drooping deformity. Our drooping index provides a quantitative measure of drooping deformity and is clinically useful to classify outcomes.
下睑重建具有挑战性，因为重建后下睑存在严重畸形的风险，如下垂、睑内翻和睑外翻。然而，这些重建后畸形的危险因素尚不清楚。本研究旨在量化使用颊旋转皮瓣重建后下睑的下垂畸形，并确定与重建后畸形相关的危险因素。
我们的研究组包括28例接受全层下睑重建的患者，使用颊旋转皮瓣进行前层重建。我们制定了下垂指数，将重建后的结果分为良好（指数<1.2）、中等（指数在1.2和1.5之间）和差（指数>1.5）。我们使用单因素分析（曼-惠特尼U检验或斯皮尔曼等级相关，取决于数据分布）确定下垂畸形的危险因素。
总体而言，下垂指数在1.0至2.11之间，平均值为1.3。11例患者结果良好，12例中等，5例较差。在中等和差结果组的17例患者中，有5例临床上出现严重睑外翻，其中4例患者需要进行修复手术。重建后下垂畸形的危险因素包括肿瘤位于内侧、切除涉及下睑水平宽度的50%以上以及颊部皮下组织的剥离延伸至颧弓以下。
颊旋转皮瓣为下睑全层重建提供了满意的结果。颊部皮下组织的剥离延伸至颧弓以下会增加术后下垂畸形的风险。我们的下垂指数提供了下垂畸形的定量测量，在临床上对结果分类很有用。
