目的:探讨利用自体游离硬腭黏膜植片替代后睑组织联合眶周表浅肌肉腱膜系统(SMAS)皮瓣转移修复缺损的前层眼睑皮肤,重建因肿瘤术后或外伤所致的全层眼睑缺损的临床疗效。方法:对16例≥眼睑全长1/2中重度全层眼睑缺损患者,全部用口腔硬腭黏膜植片替代睑板和结膜,再造后层眼睑;用眶周血供丰富的表浅肌肉腱膜系统(SMAS)皮瓣转移覆盖于硬腭黏膜上,替代缺损的眼睑皮肤肌肉层再造前层眼睑,其中10例采用眼轮匝肌单蒂皮瓣,3例为颞浅动脉皮瓣,2例为上睑皮肤轮匝肌双蒂皮瓣,1例为眉上皮瓣。手术操作中首先行硬腭黏膜移植,然后根据眼睑前层缺损的部位和范围设计眶周的SMAS转移皮瓣,手术完毕行睑缘缝合3～6mo后切开。结果:全部患者随访>12mo,硬腭黏膜植片及其转移皮瓣全部成活,无移位、感染和坏死等不良反应,无收缩,眼睑外观及功能改善满意。结论:硬腭黏膜联合SMAS皮瓣转移修复重建眼睑全层缺损,可以一次性修复眼睑缺损的皮肤、睑板、结膜,疗效肯定,具有较高的临床应用价值。

·AIM:To discuss the use of auto extricated hard palate mucosa grafting plates to substitute posterior layer eyelid tissue combined with periorbital superficial muscle aponeurosis system(SMAS)flap transfer for repairing defected anterior layer eyelid skin,and the clinical curative effects for full-thickness eyelid defects caused by reconstruction of injured eyes and eyelid malignant tumor.·METHODS:For all 16 patients 16 eyes with medium to heavily full-thickness eyelid defects larger than or equal to the full length of eyelid,oral hard palate mucosa grafting plates were used to substitute tarsal plates and conjunctivas,and reconstruct posterior layer eyelids;periorbital flood-abundant SMAS flaps were transferred to cover the hard palate mucosa and substitute the defected eyelid skin and muscle layer and reconstruct anterior layer eyelids.Among them,10 cases adopted musculus orbicularis oculi single flaps,3 cases superficial temporal artery flaps,2 cases upper eyelid skin orbicular muscle double flaps,1 case on-eyebrow inversion belt flaps.During the surgery,hard palate mucosa grafting was firstly performed,then periorbital SMAS transfer flaps was designed in accordance with part and range of the eyelid anterior defects,palpebral margins was sutured upon completion,and incised after 3-6 months.·RESULTS:For all patients who were followed up for over 12-36 months,the hard palate mucosa grafting plates and their transfer flaps survived without untoward effects of contraction,dislocation,infection or necrosis.Appearance of eyelids and functional improvements were satisfactory.·CONCLUSION:Hard palate mucosa grafting plates have a similar hardness with that of tarsal plates,good supporting effect,soft mucosa surface,no after-surgery contraction,easy availability,and high survival rate.Periorbital SMAS flaps have similar thickness and color with that of eyelids,abundant flood supply,high viability,simple operation,and minor injuries.Reconstruction of full-thickness eyelid defect with hard palate mucosa grafting combined with periorbital SMAS flap transfer can repair defected skin,tarsal plates and conjunctivas with positive curative effect and highly clinical values.·

R779.6