颞区预构复合组织瓣行全眼睑再造

发布时间：2019-03-27 19:30

【摘要】：目的：探讨应用颞区预构复合组织瓣的治疗方法修复各种原因所引起的全眼睑及周围组织缺损。背景：眼睑本身的解剖结构复杂,眼睑重建包括前层重建(皮肤和眼轮匝肌)和后层重建(睑板和睑结膜)。因外伤、肿瘤切除以致全眼睑及周围组织缺损行全眼睑再造一直是临床上的一大难题。随着近几年发展,复合组织转移修复的新方法已经越来越多的应用在治疗部分眼睑缺损中,软组织扩张器及预构皮瓣的方法在整形外科中的广泛应用,同时,眼轮匝肌蒂颞区皮瓣在尸体解剖及临床应用中的研究,临床应用广泛,手术效果确实。因此,将这几种方法结合以复合组织重建眼睑后层结合以眼轮匝肌为蒂的颞区扩张皮瓣预构眼睑的方法应用在治疗全眼睑及周围组织缺损中。方法：一期手术于颞区埋置扩张器形成扩张皮瓣,二期手术于扩张皮瓣下植入口腔黏膜及耳软骨形成预构的复合组织瓣,三期手术行以眼轮匝肌为蒂的复合组织瓣全眼睑再造术。同时,以相似的方法用于动物实验上探索应用扩张皮瓣下预制口腔粘膜及耳软骨再造眼睑结构的可行性。同时进行自身对照进一步证实复合组织的成活条件,以及后期软骨吸收的情况及粘膜挛缩的程度。结果：自2010年6月至2011年11月共入组3例外伤导致全眼睑及周围组织缺损的患者,均接受应用颞区预构复合组织瓣的治疗方法,均取得较为满意的手术效果。经1年的临床随访再造眼睑的粘膜及软骨成活良好。患者对术后义眼的佩戴效果较为满意。动物实验表明复合组织中,耳软骨进行适当的修剪及打孔处理更利于外层口腔黏膜的成活。结论：应用颞区预构复合组织瓣的治疗方法修复全眼睑及周围组织缺损与其他手术方式相比,再造眼睑更接近正常眼睑的结构,同时结合扩张皮瓣解决了全眼睑及周围组织缺损供区组织量不足的情况,手术效果好,为全眼睑的再造开辟了新的途径。
[Abstract]:Objective: to investigate the treatment of total eyelid and surrounding tissue defects caused by various causes by using temporal prefabricated composite tissue flap. Background: the anatomical structure of eyelid itself is complex. Blepharoplasty includes anterior layer reconstruction (skin and orbicularis oculi muscle) and posterior layer reconstruction (palpebral plate and eyelid conjunctiva). Total eyelid reconstruction due to trauma, tumor resection and defects of eyelids and surrounding tissues has been a major clinical problem. With the development of recent years, the new method of compound tissue transfer repair has been more and more used in the treatment of partial eyelid defect, soft tissue expander and prefabricated flap are widely used in plastic surgery, at the same time, The temporal flap pedicled with orbicularis oculi muscle is widely used in autopsy and clinical application. Therefore, these methods combined with compound tissue reconstruction of eyelid posterior layer combined with expanded temporal flap pedicled with orbicularis oculi muscle were applied to the treatment of total eyelid and surrounding tissue defects. Methods: the expanded skin flap was formed by embedding the expander in the temporal region in the first stage, and the oral mucosa and auricular cartilage were implanted under the expanded flap in the second stage to form the preformed composite tissue flap. The third stage operation was performed with compound tissue flap pedicled with orbicularis oculi muscle. At the same time, a similar method was used to explore the feasibility of reconstruction of eyelid structure by prefabricated oral mucosa and auricular cartilage under expanded flap in animal experiments. At the same time, the survival condition of compound tissue, the condition of cartilage absorption and the degree of mucosal contracture were further confirmed by self-control. Results: from June 2010 to November 2011, 3 cases of total eyelid and surrounding tissue defect caused by trauma were treated with temporal region prefabricated compound tissue flap, and satisfactory results were obtained. After 1 year clinical follow-up, the mucosa and cartilage of eyelid reconstruction survived well. The patients were satisfied with the wearing effect of the artificial eye after operation. Animal experiments showed that proper pruning and perforating of auricular cartilage were more favorable for the survival of outer oral mucosa. Conclusion: compared with other surgical methods, the reconstruction of eyelid is closer to the structure of normal eyelid by using temporal region prefabricated compound tissue flap to repair the total eyelid and surrounding tissue defect, and the results show that the reconstruction of eyelid is more similar to that of normal eyelid. At the same time, combined with the expanded flap, the insufficient amount of tissue in the donor area of the whole eyelid and surrounding tissue defect was solved. The result of the operation was good, which opened up a new way for the reconstruction of the whole eyelid.
【学位授予单位】：北京协和医学院
【学位级别】：硕士
【学位授予年份】：2013
【分类号】：R779.6

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