“半圆”皮瓣（TENZEL）

“半圆”皮瓣（TENZEL）（图6.11）

图6.11

方法

1. 对相应的外眦韧带分支行外眦切开(图6.10)。

2. 切一个半圆形的皮肤和轮匝肌皮瓣，呈高弓状，即垂直直径(约22mm)大于水平直径(约18mm)。切口应保持在眶周皮肤内，不应向外侧延伸超过眉毛外侧部分(图6.11a,b)。

注意：眼睑并没有被去神经，因为第7颅神经的分支主要在这个切口的外侧走行，并且末端纤维几乎转向垂直来支配轮匝肌。

3. 游离眶隔，松动结膜，向内侧拉眼睑以对合伤口边缘。这比通过小的外眦切开切口更容易改善暴露。

4. 行直接缝合。

5. 用4'0'不可吸收垂直褥式缝合创建一个新的外眦，将眼睑的重建部分悬吊在外眦韧带的完整分支上(图6.11c)。

注意：在下睑重建中，使重建的眼睑处于足够的张力下以防止外翻是非常重要的。

6. 用可吸收缝线缝合轮匝肌，用丝线缝合皮肤并5天后拆除。再造眼睑边缘的结膜和皮肤应用连续尼龙或可吸收缝线缝合。垂直褥式缝合应结扎在垫枕上，并在10天拆除(图6.11d)。

（以上内容翻译自《A Manual Of Systematic Eyelid Surgery 》第三版）。

TENZEL术适用于眼睑水平缺损范围介于1/3-1/2者。

为了加深对TENZEL皮瓣的理解，这里分享Richard Allen教授的相关手术演示和讲解。

This is Richard Allen at the University of Iowa. This video demonstrates the use of a Tenzel flap to repair a defect of the lower eyelid involving approximately 50% of the length of the lid. Primary closure is not possible, therefore, an interior, inferior cantholysis is performed with the needle tip cautery. The Tenzel flap is then raised by making an incision extending from the lateral canthus superior and lateral. Dissection is then carried out under the orbicularis muscle to mobilize the flap. Transposition of the flap results in some kinking of the upper lid laterally, therefore, the flap is dissected from the superior crus of the lateral canthal tendon. Closure of the defect shows that the tension on the superior crux has been relieved. The tarsus is exposed on each side of the defect. Dissection is then carried out between the orbicularis muscle and the orbital septum. A 5-0 Vicryl suture is then placed partial thickness through the anterior surface of the tarsus. Two sutures are placed. Tying the suture opposes the tarsus well.

The eyelid margin is then closed with 7-0 Vicryl suture which is placed in a vertical mattress fashion. This will result in eversion of the eyelid margin. One suture is placed at the level of the Meibomian gland orifices. The other is placed at the level of the lash follicles. The orbicularis is closed with buried interrupted 5-0 Vicryl sutures. The skin is then closed with interrupted 7-0 Vicryl sutures. This results in a small dog ear inferiorly which is excised.

Attention is then directed to reconstruction of the lateral canthus. The orbicularis of the Tenzel flap is engaged with a 5-0 Vicryl suture which then engages the superior crux of the lateral canthal tendon. Tying the suture results in recreation of the lateral canthal angle. The canthotomy incision is closed with interrupted 7-0 Vicryl sutures. The anterior lamella of the Tenzel flap is then reassociated with the posterior lamella with 7-0 Vicryl sutures. At the conclusion of the case, antibiotic ointment is placed over the repair. The patient returns in one week for reevaluation.