A Modified Hughes Flap for Correction of Refractory Cicatricial Lower Lid Retraction With Concomitant Ectropion
A Modified Hughes Flap for Correction of Refractory Cicatricial Lower Lid Retraction With Concomitant Ectropion
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DOI：
10.1097/iop.0000000000001633
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发表时间：
2020-09-01
影响因子：
2
通讯作者：
Lee, Bradford W.
中科院分区：
文献类型：
--
作者：
Chen, Ying;Al-Sadah, Zakeya;Lee, Bradford W.
简介：矫正下睑退缩通常涉及一种或多种技术，包括眼睑退缩、隔离器移植、水平收紧眼皮和面部中部提拉。然而，在以前的眼睑手术后出现瘢痕状下眼睑退缩的患者，通常会有疤痕和伴随的外翻或内翻，这会导致不可预测的伤口愈合、愈合和不理想的结果。改良的Hughes后结膜瓣通常用于修复全层眼睑缺损。以前的报道描述了在全厚眼睑切开术后，用改良的休斯瓣放置在眼睑下方治疗难治性下睑退缩。我们介绍了一种新的手术技术，在切除疤痕的下睑边缘后，使用改良的休斯瓣在颧骨上方治疗难治性瘢痕状下眼睑退缩。方法：对3例患者采用该技术治疗。下睑上缘和相关的疤痕组织被切除。一个改良的休斯瓣被移动并固定在后板残留物的上方。在皮瓣上放置一层全厚的皮片。4-5周后切开皮瓣。结果：3例均采用该术式。所有病例均为翻修性手术，其中2例有广泛的多次手术史，多次重建失败，眼睑退缩修复。所有患者在瘢痕性眼睑退缩、眼球拉伤、裸露角膜病变和伴随的瘢痕性外翻的消退方面均有改善。结论：采用改良Hughes瓣重建睑板上方，切除瘢痕边缘是矫正难治性瘢痕性下睑退缩的有效方法。在传统的下睑退缩修复技术失败的情况下，可以考虑采用这种方法进行多次手术。重建新的盖子边缘可降低卷曲风险和次优效果。
Introduction: Correction of lower eyelid retraction commonly involves one or more techniques, including recession of the eyelid retractors, spacer grafts, horizontal lid tightening, and midface lifting. However, patients presenting with cicatricial lower lid retraction following prior eyelid surgery often have scarring and concomitant ectropion or entropion that cause unpredictable wound healing, recicatrization, and suboptimal outcomes. The modified Hughes tarsoconjunctival flap is typically used to repair full-thickness eyelid defects. Prior reports describe treating refractory lower lid retraction with a modified Hughes flap placed beneath the tarsus after full-thickness blepharotomy. We present our experience with a novel surgical technique for treating refractory cicatricial lower lid retraction using a modified Hughes flap above the tarsus after excision of the scarred lid margin. Methods: Three patients were treated using this technique. The upper edge of the lower eyelid and associated scar tissue are excised. A modified Hughes flap is mobilized and secured above the posterior lamellar remnant. A full-thickness skin graft is placed over the flap. The flap is divided 4-5 weeks later. Results: This surgical technique was employed in all 3 cases. All cases were revisional, with 2 having extensive multioperative histories with multiple unsuccessful reconstructions and lid retraction repairs. All patients had improvement in cicatricial eyelid retraction, lagophthalmos, exposure keratopathy, and resolution of concomitant cicatricial ectropion. Conclusions: The technique of using a modified Hughes flap to reconstruct above the tarsus with excision of the scarred lid margin was effective in correcting refractory cicatricial lower lid retraction. This procedure can be considered in multioperative cases in which traditional techniques for lower lid retraction repair have failed. Reconstructing a new lid margin reduces the risk of recicatrization and suboptimal results.