Katayama Riku, Fujii Takako, Kanayama Chie, Sakuma Hisashi
Department of Plastic and Reconstructive Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Department of Plastic and Reconstructive Surgery, Tokyo Dental College Ichikawa General Hospital, Ichikawa, Chiba, Japan.
Arch Plast Surg. 2025 May 15;52(3):132-136. doi: 10.1055/a-2521-2337. eCollection 2025 May.
Both cosmetic and functional aspects are important in reconstructing the lower eyelid tissue defects. In this case report, we describe a two-stage reconstruction of a skin defect, including the orbicularis oculi muscle, after resection of a basal cell carcinoma using a paramedian forehead flap combined with the frontalis muscle and periosteum. In the first stage, the paramedian forehead flap, including the frontalis muscle and periosteum, was elevated, the periosteal flap was fixed to the outer orbital periosteum to lift the lower eyelid, and the skin flap, including the frontalis muscle, was sutured to the defect. In the second stage, the flap was divided and the frontalis muscle flap was sutured to the medial palpebral ligament. Electromyography at 1 year postoperatively confirmed neurotization of the transferred muscle, and at 6 months, voluntary contraction of the transferred muscle was observed during eyelid closure. These results suggest that a paramedian flap combined with the frontalis muscle and periosteum is a useful option for reconstructing horizontal skin defects involving the orbicularis oculi muscle.
在重建下睑组织缺损时，美观和功能两方面都很重要。在本病例报告中，我们描述了使用正中旁前额皮瓣联合额肌和骨膜对基底细胞癌切除术后包括眼轮匝肌在内的皮肤缺损进行两阶段重建的过程。在第一阶段，掀起包括额肌和骨膜的正中旁前额皮瓣，将骨膜瓣固定于眶外侧骨膜以提升下睑，将包括额肌的皮瓣缝合至缺损处。在第二阶段，将皮瓣断蒂，并将额肌瓣缝合至睑内侧韧带。术后1年的肌电图证实了移植肌肉的神经化，术后6个月，在闭眼时观察到移植肌肉的自主收缩。这些结果表明，正中旁皮瓣联合额肌和骨膜是重建涉及眼轮匝肌的水平皮肤缺损的一种有效选择。
