| Objective:To explore the feasibility of palmar longus tendon combined with hard palatal mucosa and nasolabial flap pedicled with angular artery in total lower eyelid reconstructionMethods:Collected the clinical data of 13 patients who underwent total lower eyelid reconstruction due to trauma or tumor resection in the First Hospital of Jilin University from 2015 to 2020,and retrospectively analyzed them.The age ranged from 23 to 61 years old,and the average age was 42.2 years old,10 cases were males(71%),3 cases were females(29%),lesions: 7 cases of left lower eyelid,6 cases of right lower eyelid,all of which involved the entire layer of the eyelid.The area of the repaired lower eyelid defect was 3cm ×1cm～4cm × 3cm.In the defect area,the hard palate mucoperiostium and palmaris longus tendon combined with nasolabial flaps are used for repair and reconstruction to achieve clinical effects with both function and beauty.Surgery usually repairs from three aspects.(1)Repair of the posterior layer of the eyelid:Take a free hard palate mucoperiosteal flap of about 3cm×1cm size,and suture it with the remaining conjunctiva of the lower eyelid fornix.(2)Take an appropriate length of the palmar longus tendon and fix it on both sides of the internal and external canthal ligaments.If the internal and external canthal ligament is defective,it can be fixed on the internal and external canthal periosteum.If the periosteum is defective,a hole can be made in the orbital wall to use the palmar longus tendon.It is fixed by steel wire,and the central part is sutured intermittently with the free transplanted hard palate mucoperiosteal flap.(3)Repair of the anterior layer of the eyelid: According to the size of the defect,the nasolabial sulcus flap pedicled with the angular artery is designed,and the whole layer of the skin is cut according to the design line.The aspect ratio does not exceed 5:1,and the rotating flap covers the defect area.The postoperative follow-up was 6 months to 1 year.A scoring scale was designed to evaluate the postoperative effects from both the appearance and function.The appearance indicators include eyelid shape,symmetry,skin color and texture,and secondary deformities of the donor site.The functional indicators include patient comfort and presence Common complications after lower eyelid reconstruction include incomplete eyelid closure,separation of the eyelid bulb,lower eyelid ectropion,and lower eyelid retraction.Then,the patient’s satisfaction with the operation was calculated based on the results.Results:The nasolabial fold flaps,palmar longus tendon and hard palate mucosa were all alive in 13 patients.The eyelid shape was basically satisfactory,and the incisions healed at first stage.During the follow-up period of 6 months to 1year,there were no obvious deformities such as lower eyelid ectropion,lower eyelid retraction,or incomplete eyelid closure;scars of the donor site incision were not obvious,and the hand function on the operated side was not abnormal.In postoperative evaluation,5 patients scored 18 points,5 patients scored 16 points,and 3 patients scored 10 points.According to postoperative results statistics,there were 10 people in the satisfied group,accounting for 76.9%,a total of 3 people in the basically satisfied group,accounting for 23.1%,and a total of 0 people in the dissatisfied group.Conclusion:(1)The "sandwich structure" of the hard palate mucoperioste and palmar longus tendon combined with nasolabial flaps can be used for total lower eyelid reconstruction.(2)The "sandwich structure" of the hard palate mucoperiostium and palmar longus tendon combined with nasolabial flaps strengthens the internal and external canthal structure,effectively maintains the lateral and longitudinal tension of the lower eyelid,and avoids possible lower eyelid ectropion,lower eyelid retraction,and lower eyelid from reconstructed tissue.Complications such as blepharoplasty have important clinical significance. |
PDF Full Text Request