Department of Ophthalmology, Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA.
Department of Ophthalmology, University of Louisville, Louisville, KY, USA.
Orbit. 2021 Dec;40(6):470-480. doi: 10.1080/01676830.2020.1820045. Epub 2020 Sep 29.
The reconstruction of large (>50%) upper eyelid margin defects can be technically challenging, with multiple approaches described in the literature. We sought to review the recent literature for new techniques or modifications to existing techniques.
We conducted a Pubmed search for technique papers on the reconstruction of large upper eyelid defects published within the past ten years with a minimum of four patients.
We identified ten articles, and divided them into techniques that use a bridging flap from the lower eyelid and those that do not. The number of upper eyelids repaired in each article ranged from 4 to 17. Most techniques could be considered either a modification of the Cutler-Beard technique or a novel anterior lamella flap laid over a graft for the posterior lamella. Postoperative complications included upper or lower eyelid cicatricial retraction, trichiasis, entropion, and lagophthalmos.
Surgeons continue to innovate for this challenging reconstructive surgery. Overall, the trend was to use a graft, most commonly tarsoconjunctiva from the contralateral upper lid, to replace the posterior lamella, and a skin flap, from the lower eyelid or from the adjacent periorbital area, to replace the anterior lamella. Bridging techniques utilized the skin; the skin, orbicularis, and conjunctiva; or a tarsoconjunctival flap from the lower eyelid. Non-bridging techniques generally used a tarsoconjunctival or substitute graft for the posterior lamella, and a skin flap for the anterior lamella.
重建>50%的上眼睑缘缺损具有一定的技术挑战性，文献中描述了多种方法。我们试图对过去十年中发表的关于重建大面积上眼睑缺损的新技术或现有技术改进的文献进行综述。
我们在 Pubmed 上搜索了过去十年中发表的关于重建大面积上眼睑缺损的技术论文，至少有 4 例患者，且使用了下眼睑桥接皮瓣的技术。
我们确定了 10 篇文章，并将其分为使用下眼睑桥接皮瓣的技术和不使用下眼睑桥接皮瓣的技术。每篇文章修复的上眼睑数量从 4 到 17 个不等。大多数技术可以被认为是 Cutler-Beard 技术的改进，或者是在前层皮瓣上覆盖移植物以修复后层皮瓣。术后并发症包括上或下眼睑瘢痕性回缩、倒睫、睑内翻和兔眼。
外科医生继续为这项具有挑战性的重建手术进行创新。总的来说，趋势是使用移植物（最常见的是对侧上眼睑的眼轮匝肌-结膜）来替代后层皮瓣，以及来自下眼睑或相邻眶周区域的皮瓣来替代前层皮瓣。桥接技术利用皮肤、皮肤、眼轮匝肌和结膜，或来自下眼睑的眼轮匝肌-结膜皮瓣。非桥接技术通常使用眼轮匝肌-结膜或替代移植物来替代后层皮瓣，以及皮瓣来替代前层皮瓣。
