From the Department of Plastic Surgery and Hand Surgery, Burn Center, University Hospital Zurich, Zurich.
Department of Ophthalmology, Cantonal Hospital Winterthur, Winterthur.
Ann Plast Surg. 2022 Mar 1;88(3):271-276. doi: 10.1097/SAP.0000000000003047.
Eyelid scarring after severe burn injury of the face is a significant complication endangering vision in addition to the burn scar sequelae. Scar contraction leads to asymmetry and malposition of the eyelid axis, resulting in corneal exposure, eyelid retraction, and incomplete eyelid closure. In consequence, dryness and irritation of the cornea can lead to keratitis, corneal opacity, and vision impairment. In this study, we present our surgical technique for lateral canthopexy in combination with full-thickness skin grafting (FTSGing) in patients with eyelid axis distortion after scar contraction of the periorbital region after severe burn injuries of the face.
In this retrospective, single-center case study, we present 5 consecutive patients who experienced severe burn injuries to the face between 2014 and 2019. Patients were suffering from ectropion and malposition of the eyelid axis. In all cases, we performed lateral transosseous canthopexy and FTSGing.
Improved symmetry and complete eyelid closure were restored in all 5 patients. The following ophthalmological examinations showed resolved corneal erosions, as well as reduction of chemosis and epiphora. Further vision impairment was successfully prohibited. Surgical revision with FTSGing was required in 2 patients because of recurrence of unilateral lower eyelid retraction.
Lateral transosseous canthopexy represents a suitable surgical method to durably correct eyelid malposition, ectropion, and incomplete lid closure in patients with severe scarring of the periorbital region after burns of the face. Early detection of patients at risk and timing of surgical intervention are of great importance.
面部严重烧伤后的眼睑瘢痕是一种严重的并发症，除了烧伤瘢痕后遗症外，还会危及视力。瘢痕收缩导致眼睑轴不对称和错位，导致角膜暴露、眼睑退缩和眼睑闭合不全。因此，角膜干燥和刺激会导致角膜炎、角膜混浊和视力障碍。在这项研究中，我们介绍了我们在面部严重烧伤后眶周区域瘢痕收缩导致眼睑轴扭曲的患者中进行外侧眶骨固定术（canthopexy）联合全厚皮片移植（full-thickness skin grafting，FTSGing）的手术技术。
这是一项回顾性的单中心病例研究，我们介绍了 2014 年至 2019 年间连续 5 例面部严重烧伤的患者。这些患者都患有眼睑轴外旋和错位。在所有病例中，我们都进行了外侧眶骨穿通固定术和 FTSGing。
所有 5 例患者的对称性和完全眼睑闭合都得到了改善。以下眼科检查显示角膜糜烂得到解决，同时减轻了球结膜水肿和溢泪。进一步的视力损害得到了成功的预防。2 例患者因单侧下眼睑回缩复发需要进行 FTSGing 的手术修正。
外侧眶骨穿通固定术是一种适合的手术方法，可以持久地矫正面部烧伤后眶周区域严重瘢痕导致的眼睑错位、眼睑外旋和不完全眼睑闭合。早期发现高危患者并及时进行手术干预非常重要。
