Lowry J C, Bartley G B, Garrity J A
Department of Ophthalmology, Mayo Clinic, Rochester, MN 55905, USA.
Ophthalmic Plast Reconstr Surg. 1997 Sep;13(3):174-88. doi: 10.1097/00002341-199709000-00004.
Second-intention healing is a time-honored method of wound management. Its role in periocular reconstruction, however, is currently controversial. The objectives of this thesis are threefold: to evaluate carefully the outcomes in a cohort of patients treated by this technique, to provide a comprehensive review of published reports, and to formulate recommendations and guidelines for appropriate application in selected patients. Eyelid and periorbital defects after excision of periocular tumors were allowed to heal by second intention in 59 patients. The locations of the wounds were the medial canthus (n = 32), lower eyelid (n = 20), upper eyelid, (n = 4), glabella (n = 2), and nasojugal fold (n = 1). Five excised areas involved the eyelid margin, and in three patients the defect included the canalicular system. The size of the defects ranged from 3 x 3 mm to 22 x 27 mm. The average duration of follow-up was 19 months (range, 6 months to 8 years). The functional and cosmetic results were satisfactory in 49 patients (83%). Complications occurred in 10 patients and included ectropion, medial canthal webbing, trichiasis, eyelid notching, and hypertrophic scarring. Only two patients, however, required secondary repair. Healing by second intention is a safe, effective, and inexpensive alternative to surgical reconstruction after tumor excision in selected patients.
二期愈合是一种历史悠久的伤口处理方法。然而，其在眼周重建中的作用目前存在争议。本论文的目的有三个：仔细评估采用该技术治疗的一组患者的治疗效果，全面综述已发表的报告，并为特定患者的适当应用制定建议和指南。59例眼周肿瘤切除术后的眼睑及眶周缺损采用二期愈合。伤口部位包括内眦（n = 32）、下睑（n = 20）、上睑（n = 4）、眉间（n = 2）和鼻颧沟（n = 1）。5个切除区域累及睑缘，3例患者的缺损包括泪小管系统。缺损大小从3×3mm到22×27mm不等。平均随访时间为19个月（范围6个月至8年）。49例患者（83%）的功能和美容效果满意。10例患者出现并发症，包括睑外翻、内眦蹼状瘢痕、倒睫、眼睑切迹和肥厚性瘢痕。然而，只有2例患者需要二次修复。对于特定患者，二期愈合是肿瘤切除术后手术重建的一种安全、有效且廉价的替代方法。
