Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine.
Division of Oculofacial Plastic and Reconstructive Surgery, Bascom Palmer Eye Institute, Miami, Florida.
Ophthalmic Plast Reconstr Surg. 2020 Sep/Oct;36(5):503-507. doi: 10.1097/IOP.0000000000001633.
Correction of lower eyelid retraction commonly involves one or more techniques, including recession of the eyelid retractors, spacer grafts, horizontal lid tightening, and midface lifting. However, patients presenting with cicatricial lower lid retraction following prior eyelid surgery often have scarring and concomitant ectropion or entropion that cause unpredictable wound healing, recicatrization, and suboptimal outcomes. The modified Hughes tarsoconjunctival flap is typically used to repair full-thickness eyelid defects. Prior reports describe treating refractory lower lid retraction with a modified Hughes flap placed beneath the tarsus after full-thickness blepharotomy. We present our experience with a novel surgical technique for treating refractory cicatricial lower lid retraction using a modified Hughes flap above the tarsus after excision of the scarred lid margin.
Three patients were treated using this technique. The upper edge of the lower eyelid and associated scar tissue are excised. A modified Hughes flap is mobilized and secured above the posterior lamellar remnant. A full-thickness skin graft is placed over the flap. The flap is divided 4-5 weeks later.
This surgical technique was employed in all 3 cases. All cases were revisional, with 2 having extensive multioperative histories with multiple unsuccessful reconstructions and lid retraction repairs. All patients had improvement in cicatricial eyelid retraction, lagophthalmos, exposure keratopathy, and resolution of concomitant cicatricial ectropion.
The technique of using a modified Hughes flap to reconstruct above the tarsus with excision of the scarred lid margin was effective in correcting refractory cicatricial lower lid retraction. This procedure can be considered in multioperative cases in which traditional techniques for lower lid retraction repair have failed. Reconstructing a new lid margin reduces the risk of recicatrization and suboptimal results.
下眼睑退缩的矫正通常涉及一种或多种技术，包括眼轮匝肌退缩、间隔物移植、水平眼睑收紧和中面部提升。然而，先前接受过眼睑手术的患者出现瘢痕性下眼睑退缩时，通常会有瘢痕和伴随的睑外翻或睑内翻，这会导致不可预测的伤口愈合、再瘢痕化和不理想的结果。改良的 Hughes 睑板结膜瓣通常用于修复全层眼睑缺损。先前的报告描述了在全层眼睑切开术后，在下睑板下放置改良的 Hughes 瓣来治疗难治性下眼睑退缩。我们介绍了一种治疗难治性瘢痕性下眼睑退缩的新手术技术，即在切除瘢痕性睑缘后，在上睑板上使用改良的 Hughes 瓣。
3 名患者采用该技术治疗。下眼睑的上边缘和相关的瘢痕组织被切除。将改良的 Hughes 瓣游离并固定在后层残端上方。将全厚皮片移植到皮瓣上。4-5 周后将皮瓣切开。
该手术技术在所有 3 例中均有应用。所有病例均为复发性病例，其中 2 例有广泛的多手术病史，有多次不成功的重建和眼睑退缩修复。所有患者的瘢痕性眼睑退缩、睑裂闭合不全、暴露性角膜炎和伴发性瘢痕性睑外翻均有改善。
在切除瘢痕性睑缘的基础上，在上睑板上使用改良的 Hughes 瓣进行重建的技术在矫正难治性瘢痕性下眼睑退缩方面是有效的。在传统的下眼睑退缩修复技术失败的多手术病例中，可以考虑采用这种方法。重建新的睑缘可降低再瘢痕化和不理想结果的风险。
