Molnar J A, Yan J G, Matloub H S
Department of Plastic and Reconstructive Surgery, Bowman Gray School of Medicine, Winston-Salem, North Carolina 27517-1075, USA.
J Reconstr Microsurg. 1998 Oct;14(7):479-82; discussion 483-4. doi: 10.1055/s-2007-1000210.
Patients with severe soft-tissue trauma to the ipsilateral upper and lower eyelid and surrounding structures represent a reconstructive challenge. The authors present a new approach to eyelid reconstruction, by creating a prefabricated free flap from the contralateral lower eyelid. New Zealand white rabbits were anesthetized, and the central artery and vein of the ear were mobilized and placed in a subcutaneous tunnel in the lower eyelid. After a delay procedure, flaps were made that measured 50 percent of the lower lid area. In an initial group (n = 9), the flaps were harvested at 3 weeks, and injected with Microfil, to demonstrate visual and radiologic patency and perfusion from the neopedicle. In a subsequent group of animals (n = 6), full-thickness defects of 50 percent of the left upper lid were created. Prefabricated free flaps from the right lower lid were transferred, anastomosing to the central artery and vein on the side of the eyelid being reconstructed. Tissue removed from the upper eyelid was placed in the defect of the lower lid donor site to serve as a control. Flaps were followed for periods of up to 6 months, documenting results photographically and by injection. Prefabricated free flaps from the lower eyelid maintained long-term patency and full-thickness perfusion from the pedicle, and also maintained size, shape, and accessory skin appendages better than composite graft controls. The authors concluded that prefabricated free flaps may be used to reconstruct eyelid defects; a surgical technique for application to human subjects is proposed.
同侧上下眼睑及周围结构发生严重软组织创伤的患者面临着重建挑战。作者提出了一种新的眼睑重建方法，即从对侧下眼睑制作预制游离皮瓣。将新西兰白兔麻醉后，游离耳部中央动静脉并置于下眼睑的皮下隧道中。经过延迟处理后，制作面积为下睑面积50%的皮瓣。在初始组（n = 9）中，3周时切取皮瓣并注射微显影剂，以显示新生蒂的可视性、放射学通畅性和灌注情况。在后续一组动物（n = 6）中，造成左上睑50%的全层缺损。将取自右下睑的预制游离皮瓣转移，与待重建眼睑一侧的中央动静脉吻合。将从上眼睑取下的组织置于下睑供区的缺损处作为对照。对皮瓣进行长达6个月的随访，通过拍照和注射造影剂记录结果。来自下眼睑的预制游离皮瓣保持了长期通畅和来自蒂部的全层灌注，并且在大小、形状和附属皮肤附属器方面比复合移植对照组保持得更好。作者得出结论，预制游离皮瓣可用于重建眼睑缺损；并提出了一种应用于人类受试者的手术技术。
