【进展】皮肤重置法的内眦赘皮切除术

发布于 2020-11-12 · 浏览 2103 · IP 重庆重庆

这个帖子发布于 4 年零 178 天前，其中的信息可能已发生改变或有所发展。

有点类似国内报道的一字法

作者单位：韩国延世大学

与其他手术比较

Other methods, such as V-W plasty, V-Y advancement flap, modified Y-V advancement flap,W-plasty,and Z-plasty around the epicanthal fold, have been used. However, prominent scarring of the medial canthal and nasal area caused by excessive tension and rigidity of the application are potential problems associated with many of these procedures.

其他常用方法，如V-W成形术、V-Y推进皮瓣、改良Y-V推进皮瓣、W形成形术和Z形内眦皱襞成形术。然而，过度的张力导致内眦部和鼻区的明显疤痕与设计严格性是会导致潜在一些问题。

手术方法

Point A was the desired location for the new medial epicanthus, and point B was where the horizontal line passing point A met the edge of the epicanthal fold (Figs. 1 and 2). After pulling the skin of the nose in the medial direction, point C was marked 2 mm medial to the lacrimal lake. Point D was marked near the area where the subciliary line of the lower eyelid met the vertical line passing through the medial limbus. Point D was variable according to the severity of epicanthal fold. The incision line was designed by drawing a curvilinear line passing through points A, C, and D. A skin incision was made from point A to point D. With this method, we can avoid incisions on the noticeable medial canthal region. The skin flap was raised with blunt dissection to avoid damaging the lacrimal canaliculus. By cutting the dense connective tissue between skin and orbicularis oculi muscle in the medial canthal area and redraping the skin flap, most of the epicanthal fold and skin tension can be released. This was the first step of our method. The next step was to release and excise the orbicularis oculi muscle beneath the epicanthal fold. Therefore, we performed two independent procedures on the skin and muscle. The extent of the dissection of the skin flap and excision of the underlying hypertrophic orbicularis muscle should be graded depending on how much the epicanthal fold is to be softened. Point A was sutured to point C on the medial canthus. At this time, point C of the skin flap was laid on the subciliary line for redraping of the skin flap. The excess area of skin flap was trimmed and the subciliary incision was closed. The dog-ear on the upper eyelid was removed and sutured with the intention of hiding the suture line along the upper eyelid crease.

A点是新内眦点的位置，B点是穿过A点的水平线与内眦赘皮边缘相交的地方（图。1和2）。在向内侧方向拉动鼻子牵拉鼻部皮肤后，C点标记在泪湖内侧2mm处。D点标记在下眼睑下缘线与角膜内侧缘的垂直线相交的区域附近。根据内眦皱襞的严重程度，D点是可变的。切口线的设计是通过a、C、D点画一条曲线。从A点到D点做一个皮肤切口切开皮肤，这样可以避免明显的内眦部切口。提起皮瓣，皮瓣下钝性剥，避免损伤泪小管。通过切断内眦区皮肤与眼轮匝肌之间致密的结缔组织，并重置皮瓣，可使大部分内眦皱襞和皮肤张力得到释放。这是我们方法的第一步。下一步是松解并切除内眦赘皮下的眼轮匝肌。因此，我们对皮肤和肌肉进行了两个独立的手术。根据内眦皱襞需要的松解程度，决定皮瓣的剥离程度和皮瓣下方肥大的轮匝肌的切除量。内眦A点与C点缝合。此时作为皮瓣重置，皮瓣的C点已被置于睫毛下切口线上。修整皮瓣多余皮瓣，缝合睫毛下切口。切除上眼睑的狗耳并缝合，缝合线可隐藏于上睑折痕中。

缺点

In a few cases, the loss of eyelashes in the medial canthal area of the lower eyelid was noted. However, the patients were unaware and did not complain about the loss of eyelashes.

少数病例下眼睑内眦区睫毛脱落。然而，患者通常不会注意到，也没有抱怨睫毛脱落。