Park D H, Ahn K Y, Han D G, Baik B S
Department of Plastic and Reconstructive Surgery at the Catholic University of Taegu, Korea.
Plast Reconstr Surg. 1998 Mar;101(3):592-603. doi: 10.1097/00006534-199803000-00005.
Thirty-three patients with severe blepharoptosis were treated by the superiorly based orbicularis oculi muscles, interdigitated orbicularis oculi-frontalis muscle flaps, or frontalis muscle flaps. The superiorly based muscle flaps are modifications of direct transplantation of the frontalis muscle to the tarsal plate on the basis of anatomic study that the frontalis muscle and its fascia are connected with the orbicularis oculi muscle at the eyebrow region. The selection of muscle flaps is based on the extent of levator function of patients. When eyelid excursion is moderate (3 to 5 mm), the orbicularis oculi muscle flap technique was effective. For patients with weak eyelid excursion (2 to 4 mm), the interdigitated orbicularis oculi-frontalis muscle flap was the procedure of choice. For patients with minimal eyelid excursion (less than 2 mm), frontalis muscle flap technique is indicated. The majority of patients recorded as satisfactory results according to the criteria of Souther and Jordan after an average follow-up period of 18.5 months. Even though four patients showed undercorrection, there has been no complete failure or laxity of the advanced flaps in our series. The orbicularis oculi muscle technique or the interdigitated orbicularis oculi-frontalis muscle flap technique offers several advantages over the conventional frontalis muscle flap technique, such as being a simple technique with a good operative field, single incision on supratarsal fold, no depression on the forehead, no risk of neurovascular injury, and relatively easy technique with less complication. The frontalis muscle flap technique is better in patients with less than 2-mm eyelid excursion to avoid recurrence even if the superiorly based frontalis muscle flap technique has some inherent shortcomings.
33例重度上睑下垂患者接受了上睑提肌肌瓣、眼轮匝肌-额肌交错肌瓣或额肌肌瓣治疗。上睑提肌肌瓣是在解剖学研究基础上对额肌直接移植到睑板的改良，即额肌及其筋膜在眉区与眼轮匝肌相连。肌瓣的选择基于患者提上睑肌功能的程度。当眼睑活动度适中（3至5毫米）时，眼轮匝肌肌瓣技术有效。对于眼睑活动度较弱（2至4毫米）的患者，眼轮匝肌-额肌交错肌瓣是首选术式。对于眼睑活动度极小（小于2毫米）的患者，应采用额肌肌瓣技术。根据Souther和Jordan的标准，大多数患者在平均随访18.5个月后结果令人满意。尽管有4例患者矫正不足，但在我们的系列研究中，没有出现晚期肌瓣完全失败或松弛的情况。眼轮匝肌技术或眼轮匝肌-额肌交错肌瓣技术相对于传统的额肌肌瓣技术具有多种优势，例如技术简单、术野良好、在睑板上缘单一切口、前额无凹陷、无神经血管损伤风险，且技术相对容易，并发症较少。对于眼睑活动度小于2毫米的患者，额肌肌瓣技术更好，即使上睑提肌肌瓣技术存在一些固有缺点，也可避免复发。
