Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiaotong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, People's Republic of China.
Department of Plastic Surgery, Third Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Aesthetic Plast Surg. 2021 Aug;45(4):1581-1590. doi: 10.1007/s00266-021-02242-2. Epub 2021 Apr 2.
Various methods have been introduced to eliminate the epicanthus; however, there are no clear guidelines to determine the optimal technique for epicanthus. We aimed to investigate the clinical effect of modified Z-plasty and modified Y-V flap on epicanthus and report our experience.
Medical records, including photographic information and scar score, of 81 eyes of 43 patients with congenital epicanthus were collected. All patients underwent epicanthus correction surgery by the modified Z-plasty or modified Y-V flap methods with a four-point design from January 2018 to December 2019 in Shanghai Ninth People's hospital and completed a follow-up of at least 6 months. The cosmetic outcome was evaluated in terms of by photographic evaluation and scar score, and the structural outcome was assessed by intercanthal distance (ICD) and palpebral fissure length, inner canthal angle, the canthal tilt angle. The results of two surgical techniques were compared and analyzed.
The cosmetic outcome of both group is good in both groups. ICD is smaller and inner canthal angle is larger in modified Z-plasty group, compared to modified Y-V flap group, respectively (P < 0.05). Patients with severe epicanthus in the modified Z-plasty group showed greater improvement in structural outcomes than in the modified Y-V flap group (P < 0.05), while those with mild epicanthus in the modified Y-V flap group showed more improvement in ICD than those in the modified Z-plasty group (P < 0.05). By 6 months, scarring in the modified Z-plasty group was more hypertrophic and obvious compared to the modified Y-V flap group (P < 0.05).
Modified Y-V flap technique caused less scarring. Conversely, the modified Z-plasty technique was more efficient in shortening the ICD and increasing inner canthal angle. While modified Z-plasty reconstruction is more suitable for patients with severe epicanthus, the modified Y-V flap is more suitable for patients with mild epicanthus.
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已经提出了各种方法来消除内眦赘皮；然而，目前还没有明确的指导方针来确定内眦赘皮的最佳技术。我们旨在研究改良 Z 成形术和改良 Y-V 皮瓣对内眦赘皮的临床效果，并报告我们的经验。
收集了 2018 年 1 月至 2019 年 12 月在上海第九人民医院采用改良 Z 成形术或改良 Y-V 皮瓣四点设计法治疗的 43 例先天性内眦赘皮患者 81 只眼的病历资料，包括照片信息和瘢痕评分，所有患者均接受了内眦赘皮矫正手术，随访至少 6 个月。采用照片评估和瘢痕评分评估美容效果，采用内眦间距（ICD）和睑裂长度、内眦角、内眦倾斜角评估结构效果。比较分析两种手术技术的结果。
两组患者的美容效果均良好。与改良 Y-V 皮瓣组相比，改良 Z 成形术组的 ICD 更小，内眦角更大（P<0.05）。改良 Z 成形术组重度内眦赘皮患者的结构改善优于改良 Y-V 皮瓣组（P<0.05），而改良 Y-V 皮瓣组轻度内眦赘皮患者的 ICD 改善优于改良 Z 成形术组（P<0.05）。术后 6 个月，改良 Z 成形术组的瘢痕增生较改良 Y-V 皮瓣组更明显（P<0.05）。
改良 Y-V 皮瓣技术导致的瘢痕增生较少。相反，改良 Z 成形术在缩短 ICD 和增加内眦角方面更有效。虽然改良 Z 成形术重建对内眦赘皮严重的患者更适用，但改良 Y-V 皮瓣更适合内眦赘皮轻度的患者。
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