Dai Xinyue, Ma Xu, Zhang Dongxue, Zhang Dapeng, Li Jiajun, Xiong Zenghui, Wang Bingyu, Liu Guofeng
Department of Plastic Surgery, the Second Affiliated Hospital of Harbin Medical University, Harbin, People's Republic of China.
Department of Plastic Surgery, Nanjing Maternity and Child Health Care Hospital of Nanjing Medical University, Nanjing, People's Republic of China.
Clin Cosmet Investig Dermatol. 2023 Jan 20;16:173-184. doi: 10.2147/CCID.S394211. eCollection 2023.
The key point of eyelid margin reconstruction is to keep both the support function and aesthetic appearance. The eyelid's complex anatomical structures make eyelid margin reconstruction demanding. Eyelid margin defects are conventionally classified by their width relative to the eyelid width: small, medium, or large. In this study, we introduce a reconstruction method for small to medium defects.
We conducted a single-center case series of patients from the practice of a single experienced plastic surgeon at a tertiary center. We included consecutive outpatients from 2014 to 2021. The inclusion criteria were (1) eyelid margin mass and (2) willingness to receive eyelid margin reconstruction by the reported method. The exclusion criteria were (1) eyelid margin mass involving most or all of the tarsus and (2) less than one year of follow-up. Patients were followed up face to face or online. Patients' demographics, clinical characteristics and outcomes, and satisfaction were collected. The clinical outcomes were assessed and scored by two plastic surgeons.
We reconstructed the anterior lamella with an advancement musculocutaneous flap and repaired the posterior lamella with a specially designed advancement tarsoconjunctival flap, of which a piece of tarsus was shaved and the corresponding remnant conjunctiva was bent forward to cover the tarsus edge to avoid ocular injury.
We included 24 patients (25 lesions). Almost all patients had eyelash discontinuity. One patient presented slight notching of the lower eyelid margin. The other patients reported no complications or recurrence. The average outcome score was 1.23±0.69, indicating that our method was excellent. All patients were very satisfied with the surgery. The average follow-up time was 5.75 years.
We report a reconstruction method for small to medium eyelid margin defects and a novel design for preventing ocular injury, which is an especially good option for transverse defects.
眼睑边缘重建的关键在于保持支撑功能和美观外观。眼睑复杂的解剖结构使得眼睑边缘重建颇具挑战性。眼睑边缘缺损通常根据其相对于眼睑宽度的宽度进行分类：小、中或大。在本研究中，我们介绍一种针对中小缺损的重建方法。
我们在一家三级中心开展了一项单中心病例系列研究，研究对象为一位经验丰富的整形外科医生所诊治的患者。纳入了2014年至2021年的连续门诊患者。纳入标准为：（1）眼睑边缘肿物；（2）愿意接受所报道的眼睑边缘重建方法。排除标准为：（1）眼睑边缘肿物累及大部分或全部睑板；（2）随访时间不足一年。患者通过面对面或在线方式进行随访。收集患者的人口统计学信息、临床特征及结局以及满意度。临床结局由两位整形外科医生进行评估和评分。
我们采用推进肌皮瓣重建前层，并用专门设计的推进睑板结膜瓣修复后层，其中削除一片睑板，将相应的残余结膜向前弯曲以覆盖睑板边缘，避免眼部损伤。
我们纳入了24例患者（25处病变）。几乎所有患者均有睫毛间断。1例患者下眼睑边缘出现轻微切迹。其他患者未报告并发症或复发情况。平均结局评分为1.23±0.69，表明我们的方法效果良好。所有患者对手术非常满意。平均随访时间为5.75年。
我们报告了一种针对中小眼睑边缘缺损的重建方法以及一种预防眼部损伤的新颖设计，对于横向缺损而言是一种特别好的选择。
