Naugle T C, Levine M R, Carroll G S
Department of Ophthalmology, Tulane University School of Medicine, New Orleans.
Ophthalmology. 1995 Mar;102(3):493-500. doi: 10.1016/s0161-6420(95)30995-5.
The purpose of this article is to demonstrate how mobilization of the orbicularis oculi muscle can improve viability, appearance, and function of free skin grafts in the periocular region. By enhancing blood supply with this technique, healing often can be achieved in difficult reconstructive cases.
Seven patients underwent orbicularis muscle mobilization before placement of free skin grafts. Two patients underwent resection of basal cell carcinomas of the lateral eyelids and canthal region requiring complex reconstructive techniques such as lateral canthal tendon reconstruction with auricular cartilage. One patient underwent upper eyelid reconstruction after total resection for sebaceous cell carcinoma with pagetoid spread. Two patients had difficult wound dehiscences that were difficult to repair primarily. In addition, the lower eyelid with recurrent basal cell carcinomas of two patients who initially had undergone reconstruction with a Hughes procedure was reconstructed using tarsal strip grafts and orbicularis muscle mobilization combined with a free skin graft.
All seven patients have viable free grafts to date, and no further problems occurred in the two patients with wound dehiscences. Follow-up ranges from 1 to 8 years.
Orbicularis oculi muscle mobilization can be combined with a variety of techniques in eyelid and periorbital surgery, including difficult wound repair, reconstruction of the lateral canthal tendon with periosteal flaps or auricular cartilage, tarsal transposition flaps, mucosal grafts, and skin grafts. The addition of this technique can enhance the blood supply to the reconstructed area and allow healing which might not be obtained otherwise.
本文旨在证明眼轮匝肌的动员如何能改善眼周区域游离皮瓣的活力、外观和功能。通过该技术增加血供，在困难的重建病例中通常可实现愈合。
7例患者在游离皮瓣移植前进行了眼轮匝肌动员。2例患者接受了外侧眼睑和眦部基底细胞癌切除术，需要复杂的重建技术，如用耳软骨重建外眦韧带。1例患者因皮脂腺癌伴派杰样扩散行全切术后进行了上睑重建。2例患者有难愈的伤口裂开，难以一期修复。此外，对2例最初采用休斯手术进行重建后复发基底细胞癌的患者，其下睑采用睑板条移植、眼轮匝肌动员联合游离皮瓣进行重建。
至今所有7例患者的游离皮瓣均存活，2例伤口裂开患者未再出现问题。随访时间为1至8年。
眼轮匝肌动员可与眼睑及眶周手术中的多种技术联合应用，包括难愈伤口修复、用骨膜瓣或耳软骨重建外眦韧带、睑板转位皮瓣、黏膜移植和皮瓣移植。增加该技术可增强重建区域的血供，并实现否则可能无法获得的愈合。
