Free Tarsal Graft and Free Skin Graft for Lower Eyelid Reconstruction
Free Tarsal Graft and Free Skin Graft for Lower Eyelid Reconstruction
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DOI：
10.1097/iop.0000000000001680
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发表时间：
2020-11-01
影响因子：
2
通讯作者：
Al-Shweiki, Sameer
中科院分区：
文献类型：
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作者：
Bortz, John G.;Al-Shweiki, Sameer
目的：确定是否重建下眼睑缺损涉及眼睑边缘的游离睑板移植和覆盖的游离皮肤移植，没有保留或提供任何血管support.Methods的，将产生可接受的功能和美容效果：我们在这里介绍了一个临床系列的4例患者之间治疗2019年4月和2019年9月谁接受了重建大的癌后切除，眼睑边缘包括眼睑缺损。手术由同一外科医生（J.G.B.）在纽约的韦斯特切斯特医疗中心，眼科和多布斯费里医院。不保留结膜蒂（改良Hughes手术），也不使用肌皮瓣或其他血管化皮瓣，用游离睑板移植物和单独的覆盖游离皮肤移植物重建下眼睑。测量的主要结果是眼睑贴附到地球仪，边缘反射距离2至少术后6个月，眼表完整性，患者的舒适度和患者满意度的procedure.Results：在临床系列包括的患者年龄范围从73到82，3男1女。每例患者近期均行Moh癌切除术（3例基底癌; 1例鳞状癌），导致下眼睑大组织缺损。所有癌均为T1 N 0 M0。重建眼睑的平均术后边缘反射距离2为5.5 mm，范围为5-7.5 mm。4例患者中有2例在初次重建后2-3周内因外侧睑外翻或裂开接受了二次翻修。所有眼睑在翻修后均与眼球对置良好（2号患者的鼻眼睑除外，该患者的鼻眼睑因之前在同一眼睑中进行的癌切除术而既存外翻）。功能和美学结果与改良Hughes手术相同。所有4例患者都很高兴，他们已经选择接受的程序正在讨论.Conclusion：在这个临床系列的4例患者，重建下眼睑缺损与游离睑板移植和覆盖的游离皮肤移植导致在一个可接受的功能和美学下眼睑表明，保留或提供血管支持的前或后板可能是没有必要的。
Purpose:To determine whether reconstruction of lower eyelid defects involving the eyelid margin with a free tarsal graft and an overlying free skin graft, without retention or provision of any vascular support, would yield acceptable functional and cosmetic results.Methods:We present here a clinical series of 4 patients treated between April 2019 and September 2019 who underwent reconstruction of large postcarcinoma excision, eyelid-margin-inclusive eyelid defects. Surgery was performed by the same surgeon (J.G.B.) at the Westchester Medical Center, Department of Ophthalmology and Dobbs Ferry Hospital in New York. Without retaining a conjunctival pedicle (modified Hughes procedure), and without a myocutaneous or other vascularized flap, the lower eyelids were reconstructed with a free tarsal graft and a separate overlying free skin graft. The primary outcomes measured were eyelid apposition to the globe, margin reflex distance 2 at least 6 months postoperatively, ocular surface integrity, and patient comfort and patient satisfaction with the procedure.Results:The patients included in the clinical series ranged in age from 73 to 82, 3 were men and 1 women. Each had recent Moh's excision of carcinoma (3 basal; 1 squamous) resulting in large tissue defects of the lower eyelids. All carcinomas were T1N0M0. The mean postoperative margin reflex distance 2 of the reconstructed eyelids was 5.5 mm, range 5-7.5 mm. Two of the 4 patients underwent a secondary revision within 2-3 weeks following initial reconstruction for lateral ectropion or dehiscence. All eyelids were well-opposed to the globes after revision (except for the nasal eyelid in patient number 2 who had a preexisting ectropion from prior carcinoma excision in the same eyelid). Functional and esthetic results were on par with those of the modified Hughes procedure. All 4 patients were pleased that they had chosen to undergo the procedure being discussed.Conclusion:In this clinical series of 4 patients, reconstruction of lower eyelid defects with a free tarsal graft and overlying free skin graft resulted in an acceptable functional and esthetic lower eyelid suggesting that retention of or provision of vascular support in either the anterior or posterior lamella may not be necessary.