Department of Clinical Sciences Lund, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden.
Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden.
Ophthalmic Plast Reconstr Surg. 2022;38(2):166-169. doi: 10.1097/IOP.0000000000002015.
The aim of this study was to monitor blood perfusion in human upper eyelid skin flaps and examine how the perfusion is affected by the thickness of the flap.
Twenty upper eyelids were dissected as part of a blepharoplasty procedure in patients. The medial end of the blepharoplasty flap remained attached to mimic a flap design often used in reconstruction in the periocular area, a myocutaneous flap in which the blood supply follows the fibers of the orbicularis muscle and is thus parallel to the long axis of the flap. The muscle was thereafter dissected from the flap to create a cutaneous flap. Blood perfusion in the 2 types of flaps was compared using laser speckle contrast imaging.
Blood perfusion decreased gradually from the base to the tip of all the flaps. Perfusion was significantly higher in the myocutaneous flaps than in the cutaneous flaps (p < 0.0004): 69% in the myocutaneous flaps and 43% in the cutaneous flaps, measured 5 mm from the base. Blood perfusion was preserved to a greater extent distally in the myocutaneous flaps (minimum value seen at 25 mm) than in the cutaneous flaps (minimum seen at 11 mm).
Blood perfusion was better preserved in myocutaneous flaps, including both skin and the orbicularis oculi muscle, than in cutaneous flaps. This may be of clinical interest in patients with poor microcirculation in which a long flap is required for reconstructive surgery.
本研究旨在监测人类上眼睑皮瓣的血液灌注情况，并探讨皮瓣厚度如何影响灌注。
在患者的眼睑成形术过程中解剖了 20 个上眼睑。为了模拟在眼眶区域重建中经常使用的皮瓣设计，保留了眼睑成形皮瓣的内侧端，这是一种眼轮匝肌肌皮瓣，其血液供应沿着眼轮匝肌纤维，因此与皮瓣的长轴平行。此后，将肌肉从皮瓣上解剖下来，形成一个皮瓣。使用激光散斑对比成像比较两种皮瓣的血液灌注。
所有皮瓣的血液灌注从基部到尖端逐渐减少。在肌皮瓣中的灌注明显高于在皮瓣中的灌注（p < 0.0004）：距基部 5 毫米处肌皮瓣为 69%，皮瓣为 43%。在肌皮瓣中，血液灌注在更远的部位得到更好的保留（在 25 毫米处看到的最小值），而在皮瓣中则在 11 毫米处看到的最小值）。
包括皮肤和眼轮匝肌在内的肌皮瓣的血液灌注比皮瓣更好地保留。对于需要进行重建手术的微循环较差的患者，这可能具有临床意义。
