摘要
目的探讨将提上睑肌腱膜和苗勒氏肌复合组织瓣翻转延长,矫治重睑术后所致上睑退缩的临床效果。方法本组共33例(42只眼),均为南昌美林医疗美容门诊部收治的重睑术后上睑退缩的女性患者,根据术前评估的结果,采用提肌腱膜和苗勒氏肌复合组织瓣翻转瓣的方法,沿原重睑术切口,尽可能地去除原切口瘢痕,并广泛松解粘连。在眶隔和提上睑肌腱膜之间以及提上睑肌腱膜及苗勒氏肌和结膜之间广泛分离,形成包含提上睑肌腱膜和苗勒氏肌的复合组织瓣,在距复合组织瓣游离端上方的相应位置,平行于上睑板上缘横行切开部分组织,向复合瓣游离端剥离,将复合瓣分为深浅两层,形成蒂在游离端的腱膜翻转瓣。将翻转瓣水平褥式缝合固定于睑板上缘。切取颊脂肪垫,平铺于提上睑肌腱膜和眶隔脂肪之间,于周边分别固定缝合,常规重睑成形术缝合法缝合切口。结果本组33例42只眼,术后切口均一期愈合,7d拆线,有程度不等的瘢痕增生,3~6个月恢复正常,移植的颊脂肪成活良好,术后无结节、液化、不平整等并发症。随访3~12个月,平均6个月时进行静态和动态评估。静态评估:上睑缘比术前平均下降2mm;动态评估:上睑缘平均下降3mm。除3例(9%)上睑退缩矫正不足,2例(6%)于术后3个月后复发,余28例(85%)矫正术后上睑缘遮盖角膜2mm,效果均满意。结论提上睑肌腱膜和苗勒氏肌复合组织瓣翻转延长,矫治重睑术后所致上睑退缩的临床效果较好。
Objective To discuss a method, increasing the resistance and decreasing the power of the levator palpebrae superioris, to treat the upper eyelid retraction, after upper blepharoplasty, and summarize the feasibility and efficacy of this operation. Methods A total of 33 female patients (42 eyes) with upper eyelid retraction after blepharoplasty were treated. According to preoperative evaluation, an adjusted method, levator tendon membrane and Muller′s muscle compound tissue turnover flap, was selected. Following the incision of past blepharoplasty, scar and adhesions were removed as much as possible. The space between orbital septum and levator palpebral tendon membrane was widely separated, as well as the space between levator palpebral tendon membrane and Muller′s muscle, and the conjunctiva. A composite tissue flap consisting of levator palpebral tendon membrane and Muller′s muscle was formed. At the spot above the end of the composite tissue flap, paralleling to the upper edge of upper tarsal plate, the tissue was stripped. The compound flap was divided into two layers, a deep and a shallow layer, to form the aponeurosis turnover flap with pedicle at the free end. The turnover flap was horizontally sutured to the upper edge of tarsal plate. The buccal fat pad was cut and covered, between the levator palpebral tendon membrane and the orbital septum fat. At the end, conventional blepharoplasty was performed to close the incision. Results All the incisions were primary healed. Stitches were taken out 7 days after surgery. There was different scar proliferation. The recovery period last 3-6 months. Transplanted buccal fat was survived, without nodule, liquefaction, unevenness or other complications. All patients were followed for 3 to 12 months, with a mean follow-up of 6 months, for static and dynamic assessment. In static evaluation, the upper palpebral margin decreased by 2 mm. The upper palpebral margin decreased by 3 mm on average. Three cases (9%) had insufficiently corrected upper eyelid retraction, 2
作者
甘宇阳
甘海平
万珺
文辉才
Gan Yuyang;Gan Haiping;Wan Jun;Wen Huicai(Jiangxi Medical College, Nanchang University, Nanchang 330006, China;Jiangxi Nanchang Meilin Medical Cosmetic Hospital, Nanchang 330006, China;Department of Plastic and Cosmetic, First Affiliated Hospital of Nanchang University, Nanchang 330006, China)
出处
《中华整形外科杂志》
CAS
CSCD
北大核心
2019年第2期170-175,共6页
Chinese Journal of Plastic Surgery
关键词
上睑退缩
修复
重睑成形术
Retraction of upper eyelid
Repair
Double eyelid plasty
