Modified second stage Hughes tarsoconjunctival reconstruction for lower eyelid defects

To describe a novel technique utilizing an amniotic membrane graft (AMT) to create the mucocutaneous portion of the lower eyelid margin in a modified Hughes eyelid reconstruction for secondary revision or prevention of a hyperemic, hypertrophic conjunctival margin with excessive discharge. This was a retrospective, non-comparative interventional study. Thirty consecutive patients who underwent a modified Hughes reconstruction were included. The first step of the reconstruction was performed in a standard fashion using a tarsoconjunctival flap from the ipsilateral upper eyelid. The second stage was accomplished by the division of the tarsoconjunctival flap. The modification of the procedure included the addition of AMT (Ambio 5®, IOP Ophthalmics, CA) to the new mucocutaneous junction. Main outcome measures included the post Mohs surgery defect size, post-reconstruction complications. One patient received AMT for a revision of a hyperemic lid margin following reconstruction, while 29 subsequent patients received AMT as a primary procedure. The mean size of the post-Mohs defect was 23.75 ± 6.6 mm² horizontally and 9.1 ± 5.4 mm² vertically, involving 79.53 ± 16.8% of the lower eyelid. There was no evidence of hyperemic or hypertrophic margin at a mean follow-up of 4.41 ± 2.91 months. The addition of an AMT for the revision, or as a primary procedure for prevention of a hyperemic, hypertrophic eyelid margin with excess mucus production in the post-Hughes lower eyelid reconstruction has favorable outcomes in this preliminary study, however warrants further investigation with larger number of patients and longer follow-up.     

Total lower lid reconstruction:clinical outcomes of utilizing three-layer flap and graft in one session

METHODS: Seventeen patients with total or near total lower eyelid defect were included. The defects were reconstructed in three layers. Posterior lamella was reconstructed by using tarsoconjunctival free graft from the ipsilateral upper lid and periosteal flap from lateral orbital rim. Mobilization of residual orbicularis muscle provided a rich blood supply; and the anterior lamella was reconstructed by skin flap prepared from upper lid blepharoplasty as a one-pedicular or bipedicular bucket handle flap.RESULTS: The cause of lower eyelid defect was basal cell carcinoma in 15 patients and trauma in two of them. No intraoperative and postoperative complication occurred. Patients were followed from 10 to 15mo postoperatively. Cosmetic results were favorable in all patients and we had acceptable functional results. Thickness of the reconstructed tissue was a concern in early postoperative period.CONCLUSION:Three-layer lower lid reconstruction in one session is an effective technique for total lower lid reconstruction with minimal complications and acceptable functional and aesthetic outcomes and can be considered as a safe alternative for the preexisting techniques.     

Infra orbital bipedicled bridge flap in lower lid reconstruction

The infraorbital bipedicled skin-muscle-flap is a well vascularized flap, which provides a good blood supply for underlying free grafts. The main disadvantage when using this flap is the fact that the free skin graft, which is necessary for closure of the secondary defect, shows an unattractive appearance fora longer period of time. In my opinion the use of the bipedicled flap is indicated only in patients with total lower lid loss combined with defects at the inner and outer canthus. In cases of simple lower lid loss other well known procedures should be preferred.     

“风筝”皮瓣在外伤后眉部分缺损中的临床应用

目的 探讨“风筝”皮瓣一期修复外伤后眉部分缺损的应用.方法 自2009年以来,根据外伤后眉缺损的位置、范围等应用“风筝”皮瓣一期修复眉毛轻、中度缺损17例.术后随访时间3～12个月.结果 所有皮瓣全部成活,17例皮瓣切口均Ⅰ期甲级愈合,皮瓣的质地、颜色、眉毛分布密度与健侧眉部大致相同,术后瘢痕隐蔽,眉部无臃肿厚重感,外形美观.结论 “风筝”皮瓣是外伤后一期修复眉轻、中度缺损的良好方法.     

Management of complications following dermis-fat grafting for anophthalmic socket reconstruction

Sixty consecutive cases of dermis-fat grafts for anophthalmic socket reconstruction were reviewed to examine the frequency, severity, and management of postoperative complications. In seven patients, the conjunctiva failed to resurface the graft and central ulceration developed. Ten cases resulted in enophthalmos. Two patients developed keratinized sockets with chronic discharge and desquamation. Three patients required excision of conjunctival granulomas. One patient developed a primary graft infection. A donor site hematoma occurred in one patient. Secondary surgical intervention was required in ten patients. Nine complications in eight patients were managed in the office; five complications in four patients were observed and subsequently resolved without surgical intervention. Most complications occurred in patients with severely traumatized sockets who had undergone extensive earlier ocular surgery, or who had a systemic disease contributing to defective wound healing.     

Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM: To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS: The clinical data of 23 patients (23 eyes) who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed. All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterior- or posterior-layer eyelid defects. The survival rate of the propeller flap, eyelid function and appearance, tumor recurrence rate, and patient satisfaction were evaluated after the surgery.RESULTS: The patients consisted of 12 men and 11 women, aged 31–82y (mean, 58.9y). The longest follow-up time was 5y, and the shortest was 3mo. All the propeller flaps survived well. There was no significant difference in color and luster between the flap and adjacent tissues, and there was no dog ear phenomenon. No obvious scarring was observed. There were no obvious abnormalities of eyelid morphology or function, and no adverse complications such as exposure keratitis, entropion, ectropion, ptosis, and eyelid retraction. No tumor recurrence was found at the time of the last follow-up. All patients were satisfied with the surgical results.CONCLUSION: The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactory outcomes in terms of eyelid function and esthetics, and merits clinical application.     

两种自体结膜移植在翼状胬肉手术中的疗效观察

目的探讨自体单纯结膜瓣移植术和角膜缘干细胞结膜瓣移植术在治疗翼状胬肉中的疗效。方法回顾2007年6月至2010年6月在我院门诊行单纯结膜瓣移植术和角膜缘干细胞结膜瓣移植术治疗翼状胬肉的病例共56例(56只眼),其中单纯结膜瓣移植的35只眼,角膜缘干细胞结膜瓣移植的21只眼,比较两者术后复发等情况。结果随访6~24个月,单纯结膜瓣移植术治愈32只眼,复发3只眼,有效率93.8%;角膜缘干细胞结膜瓣移植术治愈20只眼,复发1只眼,治愈率95.2%。两组治愈率比较,差异无统计学意义(P>0.05)。结论两组自体结膜移植术治疗翼状胬肉方法简单,疗效相近,复发率低,是治疗翼状胬肉较为理想的手术方式,值得临床推广应用。     

结膜囊成形术矫治无眼球性结膜囊狭窄

目的 评价几种结膜囊成形手术的疗效。方法 各种原因引起的结膜囊狭窄及闭锁87例分别用羊膜、皮肤、自体结膜岛状移植做结膜囊成形术行回顾性研究。结果 随访6-52月,无继发感染,75例治愈,能放置正常大小义眼片,外观满意,9例好转,能放置较小眼片,3例无效,重新手术。结论 对Ⅰ°、Ⅱ°结膜囊狭窄结膜缺损可用羊膜移植或自体结膜岛状移植,对Ⅲ°和结膜囊闭锁可用游离皮片移植,埋线法穹隆加深术能抵抗术后结膜囊收缩,眼座植入与结膜囊成形术可同期进行。     

《外鼻缺损修复重建方法的研究进展》点评

外鼻缺损修复重建是整形外科富有挑战性的临床难题之一。由于外鼻缺损的位置、范围和层次不同,虽然需要修复或再造的方法也多种多样,但是在修复重建必须要遵循亚单位和分层重建等原则,这样方能获得良好的临床效果。外鼻既是一个美学器官,也是一个功能性器官,故在手术修复过程中时刻要兼顾外形和鼻通气功能,这就要求我们在修复过程中结合外鼻缺损实际情况,制订个性化的治疗方案。本文从临床实践出发对《外鼻缺损修复重建方法的临床进展》进行点评。     

Superiorly hinged blepharoplasty flap for reconstruction of medial upper eyelid defects following excision of xanthelasma palpebrum

This paper documents an interventional case series which describes a novel technique for reconstructing large medial upper eyelid skin defects following excision of xanthelasma palpebrum. All visible upper eyelid xanthelasma is excised and a superiorly hinged blepharoplasty skin flap is created with a classic skin crease and lateral blepharoplasty incision, the latter acting as an effective 'back-cut' to allow medial advancement of the flap into the defect. Excess triangles of skin are excised and the flap is sutured without tension into the defect in a conventional manner. The patients selected were patients with medial upper eyelid skin defects not amenable to direct closure following surgical excision of xanthelasma. The main outcome measures were the upper eyelid aesthetic and functional outcome, postoperative complications and need for revisionary surgery. In our study seven patients with bilateral medial upper eyelid xanthelasma excised and reconstructed with this technique were identified. Good aesthetic outcome and high patient satisfaction without functional compromise was achieved in all patients at the last follow-up visit. Patient age ranged from 30–52 years old. Follow up ranged from 8 to 18 months. In conclusion, the superiorly hinged blepharoplasty skin flap is a novel and simple technique for the reconstruction of skin defects that are not amenable to direct closure following xanthelasma excision. It avoids the complications of skin grafting and non-surgical ablative methods, particularly in dark-skinned patients.     

干细胞移植与角膜功能重建的研究进展及其存在的问题

近年来,干细胞移植,包括自体或异体角膜缘干细胞、口腔黏膜上皮以及体外培养的干细胞移植进行角膜功能重建的基础研究取得了一些进展,在临床应用中也得到了较好的治疗效果,但对眼表严重损伤的治疗效果、远期治疗评价和移植细胞的体内转归方面仍无定性的结论。对体外培养的干细胞移植重建角膜功能的基础研究和临床应用方面的研究进展进行介绍和比较,并对存在的问题进行讨论。     

Reconstruction of the eyelid using a myocutaneous island flap

Traditionally, skin flaps have been based upon a contiguous skin pedicle. Recently the concept has re-emerged that the important blood supply frequently lies subjacent to the flap. A temporally based island flap composed of skin and orbicularis muscle, nourished only by its subjacent pedicle, has been successfully used in the reconstruction of 91 eyelid defects.     

保存羊膜移植在眼表重建方面的临床应用

目的：观察和探讨保存人羊膜移植在眼表重建方面的临床应用和作用机制。 方法：采用保存人羊膜移植治疗各种原因造成的眼表疾患共144例（154眼）,术后随访观察4mo～1a。 结果：术后患者眼部充血、刺激症状均较轻,约在1～2wk后移植区水肿消退。111眼（72．1％）视力有提高;147眼（95．5％）一次性达到治疗效果。 结论：保存人羊膜移植能够安全、有效地重建眼表疾患患者的眼表,值得广泛应用。     

Auricular skin-cartilage sandwich graft technique for full-thickness eyelid reconstruction

Full-thickness deficiency of eyelid tissues can result in coloboma or retraction or both. Here we report our initial experience on the use of auricular skin-cartilage sandwich graft technique for full-thickness eyelid deformities. Five patients (4–32 years) underwent the procedure. Patients with full-thickness eyelid deformity were included. Three patients were operated for large-sized coloboma and two for eyelid retraction. One patient had congenital, and four patients had acquired etiology. The following parameters were specifically assessed: correction of deformity, ocular surface problems, graft status, and epithelization of skin-cartilage graft. All the patients had a good correction of eyelid position, except one patient who had severe eyelid retraction (8 mm) at presentation. None of our patients had corneal erosion/defect, persistent ocular surface redness, or graft loss. The auricular skin-cartilage sandwich graft technique produces optimal results with no graft loss. Advancement of orbicularis muscle in between the auricular skin and cartilage grafts (sandwich technique) is an imperative step that leads to the survival of both grafts.     

Same stage reconstruction of the tissue defects with island myocutaneous flap in head and neck surgery

Objective In order to promote surviving quality and period, enlarge operative ranges of head and neck surgery, this paper was to summarize retrospectively the clinical experience of 104 cases reconstructed by island myocutaneous flap since 1985. Methods To use four kinds of island myocutaneous flap, forehead,infrahyoid,trapezius and pectoralis major myocutaneous flap, repaired and reconstructed the large defects of ten anatomical regions in 104 cases of carcinoma of head and neck, at the same stage. Results Of the 104 cases, myocutaneous island flaps fully survived in 91cases （87.6%） , all necrosis in 4 cases （4/104,3.8%） , partial necrosis of skin island with that the muscular layer was still viable in 9 cases （9/104,8.6%） , haematoma in 7 cases （7/ 104,6.7% ）,infection in 11 cases（ 11/104,10.5% ）. Ⅰ stage and Ⅱ stage surviving rates of the flaps were 87.6% （ 91/104 ） and 8.6% （ 9/104 ） , respectively. 100 cases of the these patients were radiated with 40 ～ 70 Gy after reconstructing operation and no one appeared the complications of myocutaneous flap necrosis and fission. Conclusion It has excellent anti-infection and endurance of radiation. It is simple, convenient and has higher successful rate and satisfactory efficacy for using the four flaps. It is important to choice projects according tumor region and defect range.     

羊膜移植眼表重建术的临床观察

目的评价保存羊膜移植重建眼表治疗眼表疾患的疗效。方法2001年7月~2004年7月我院住院的眼表疾病16例(16眼)(化学烧伤引起的睑球粘连、瘢痕性结膜囊狭窄8例,顽固性角膜上皮缺损3例,复发性翼状胬肉切除后大面积结膜缺损5例)进行单层保存羊膜移植重建眼表,术后随访6~12月,行视力及裂隙灯显微镜等眼科常规检查,观察羊膜植片及角结膜上皮愈合情况。结果所有术眼均未见羊膜植片溃烂或溶解。术后早期(1周内)羊膜植片有轻度水肿,后逐渐透明。所有术眼眼表得以重建,随访期间未见复发。结论羊膜作为一个含基膜和基质成分的胶原支架,可以使受体的结膜或角膜上皮细胞扩展及移行于其上,达到真正的结膜及角膜眼表的重建,是眼表重建术的一大进展。     

EYELID RECONSTRUCTION USING A MONOPEDICLE FLAP AND BUCCAL MUCOSA: REPORT OF 15 CASES

A method is described for eyelid reconstruction to close a large defect involving the lid margin using a myocutaneous flap over a free buccal mucosal graft. The procedure was performed on 15 patients over a three-year period. Thirteen patients had loss of lower lid tissue alone. One included the lateral canthus and one over 50% of both upper and lower lids. Results were good in all patients except the one with extensive reconstruction of both lids. Advantages over other techniques of lid reconstruction include ease of surgery, adaptability of the technique to any eyelid site, good tissue match and the need for only a one-stage procedure.     

颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损

目的探讨颞浅动脉顺行岛状皮瓣修复重度眼睑及眶周组织缺损的适应证、安全性和有效性。方法根据颞浅血管的解剖分布,制备以颞浅动脉为蒂形成的顺行岛状皮瓣,通过皮下隧道移转至缺损区,修复各种原因所致的重度眼睑及眶周组织缺损患者18例（18眼）。术后随访6个月,观察皮瓣存活、眼睑功能恢复情况和手术效果。结果16例皮瓣完全存活,皮瓣颜色与受区皮肤相近,质地柔软,皮瓣感觉功能良好,睑裂闭合良好,外观满意。1例术后早期出现静脉回流障碍,经积极处理,皮瓣远端有小片表皮坏死。1例皮瓣因严重静脉淤滞坏死,术后3个月行游离植皮术,植皮存活。6例患者因皮瓣肿胀,行Ⅱ期修整术。结论颞浅动脉顺行岛状皮瓣具有血供丰富、色泽质地与受区相近等优点,是修复重度眼睑及眶周组织缺损并重建眼睑功能和外观理想的皮瓣。     

Reconstruction Following Subtotal Full-Thickness Upper Eyelid Resection with Preservation of the Lid Margin

Purpose: To describe a modification of a technique for upper eyelid reconstruction previously described by Patrinely et al. Methods: Radical excision of a large adenoid cystic carcinoma of the upper eyelid resulted in a subtotal full-thickness eyelid defect with preservation of 2 mm of eyelid margin. Reconstruction was performed with a free transconjunctival graft of maximum size from the contralateral upper eyelid, an overlying bipedicled skin-orbicularis oculi muscle flap and a free skin graft. Results: With this one-step technique, a good cosmetic and functional result could be obtained. Conclusion: If the eyelid margin can be spared, reconstruction of even very large upper eyelid defects with a modification of the technique reported by Patrinely et al. may yield a good result.