Dailey R A, Gray J F, Rubin M G, Hildebrand P L, Swanson N A, Wobig J L, Wilson D J, Speelman P
Oculoplastics Service, Portland Veterans Affairs Medical Center, Oregon, USA.
Ophthalmic Plast Reconstr Surg. 1998 Jan;14(1):9-12. doi: 10.1097/00002341-199801000-00003.
The use of trichloroacetic acid (TCA) as a periorbital and eyelid peel for skin rejuvenation is gaining significant acceptance among oculoplastic surgeons, dermatologists, and other surgery groups. In spite of the current enthusiasm, there remain potentially serious complications resulting from any periorbital peel. Cases of cicatricial ectropion have been reported in phenol-peeled patients, and lower eyelid ectropion has reportedly occurred in patients undergoing deep eyelid peel in conjunction with a blepharoplasty (1,2). To avoid this complication, it is necessary to better understand the depth of the wound produced by different strengths and combinations of peeling agents applied to living eyelid tissue and, more important, to determine the concentrations of TCA that are likely to lead to cicatricial ectropion when applied in a consistent fashion. We chose upper-eyelid skin because it is easier to obtain for histopathologic study than lower-eyelid skin and, in our experience, is more sensitive to hypertrophic changes after chemical peeling or carbon dioxide laser resurfacing. We applied TCA to the preseptal skin of 10 patients 48 h before standard upper-eyelid blepharoplasty. The acid was applied to produce a "frost," using varying concentrations of acid, ranging from 20 to 50%. The treated skin removed at the time of blepharoplasty was reviewed in a masked fashion by a dermatopathologist to determine the depth of necrosis. We found that superficial peels with necrosis involving 30% of the epidermis were produced by the lowest-concentration combination of TCA applied (20% followed by 0%). As the strength increased, so did the depth of peel. The combination of 50% followed by a second application of 50% produced the deepest peel, with necrosis into the papillary dermis. This finding would indicate that the chance of developing cicatricial ectropion with any of the tested combinations of TCA should be very remote.
使用三氯乙酸（TCA）进行眶周和眼睑皮肤剥脱以实现皮肤年轻化，在眼科整形医生、皮肤科医生及其他外科手术团队中越来越被广泛接受。尽管目前颇受青睐，但任何眶周皮肤剥脱都可能引发严重并发症。已有苯酚剥脱患者出现瘢痕性睑外翻的病例报道，据报道，在联合眼睑成形术进行深层眼睑剥脱的患者中也发生了下睑外翻（1,2）。为避免这种并发症，有必要更好地了解应用于活体眼睑组织的不同强度和组合的剥脱剂所造成伤口的深度，更重要的是，确定以一致方式应用时可能导致瘢痕性睑外翻的三氯乙酸浓度。我们选择上睑皮肤是因为与下睑皮肤相比，它更容易获取用于组织病理学研究，而且根据我们的经验，在化学剥脱或二氧化碳激光换肤后，上睑皮肤对肥厚性改变更敏感。我们在标准上睑成形术48小时前，将三氯乙酸应用于10例患者的睑前皮肤。使用20%至50%不等的不同浓度酸来产生“霜白”效果。在睑成形术时切除的经处理皮肤由皮肤病理学家以盲法进行检查，以确定坏死深度。我们发现，应用最低浓度组合的三氯乙酸（20%后接0%）产生了累及30%表皮的浅表剥脱。随着强度增加，剥脱深度也增加。50%后再应用一次50%的组合产生了最深的剥脱，坏死达乳头层真皮。这一发现表明，使用任何测试的三氯乙酸组合发生瘢痕性睑外翻的可能性应该非常小。
