Anderson R L, Weinstein G S
Arch Ophthalmol. 1987 Apr;105(4):570-6. doi: 10.1001/archopht.1987.01060040140052.
We describe a technique for total lower eyelid reconstruction utilizing a full-thickness bipedicle flap from the upper eyelid. The levator aponeurosis and Müller's muscle are recessed to avoid upper eyelid retraction. The key to performing this operation is a thorough knowledge of eyelid anatomy and techniques for preserving its microvascular blood supply. The bipedicle flap requires meticulous surgical technique but has many advantages over standard types of total lower eyelid reconstruction, including the following: excellent tissue match and cosmesis are obtained with single-stage reconstruction; distal flaps and grafts are avoided; open palpebral fissure is maintained, resulting in rapid rehabilitation; posterior lamella of tarsus, rather than substitute, is utilized; anterior lamella of functional orbicularis is utilized for support and closure; pedicles suspend and support the eyelid, decreasing lower eyelid retraction, laxity, and ectropion; allows simultaneous reconstruction of canthal defects; and is faster than other forms of total lower eyelid reconstruction. The results of 14 total lower eyelid reconstructions are presented. Minor canthal deformities, the most frequent complication, are easily corrected. This technique should be considered as an alternative to other procedures in cases of total lower eyelid reconstruction.
我们描述了一种利用上睑全厚双蒂皮瓣进行下睑全层重建的技术。提上睑肌腱膜和米勒肌被折叠以避免上睑退缩。实施该手术的关键是全面了解眼睑解剖结构以及保留其微血管血供的技术。双蒂皮瓣需要精细的手术技巧，但与标准类型的下睑全层重建相比有许多优点，包括：通过一期重建可获得极佳的组织匹配和美容效果；避免了远端皮瓣和移植；保持睑裂开放，实现快速康复；利用睑板后层而非替代物；利用功能性眼轮匝肌的前层进行支撑和闭合；蒂部悬吊并支撑眼睑，减少下睑退缩、松弛和外翻；可同时修复眦部缺损；并且比其他形式的下睑全层重建更快。本文展示了14例下睑全层重建的结果。最常见的并发症——轻微眦部畸形很容易矫正。在进行下睑全层重建时，应将该技术视为其他手术方法的替代方案。
