Hughes改良瓣修复大面积下睑全层缺损的临床效果

doi:10.6040/j.issn.1671-7554.0.2024.0606

摘要/Abstract

摘要： 目的评价Hughes改良瓣修复大面积下睑全层缺损的临床疗效。方法前瞻性研究,纳入大面积下睑全层缺损患者53例,按照手术方式分为对照组(n=28)和改良组(n=25)。对照组采用以Muller肌-结膜为蒂的上睑板-睑结膜瓣联合游离皮片修复下睑;改良组采用以上睑提肌腱膜-Muller肌-结膜为蒂的上睑全层瓣修复下睑。术中测量下睑缺损面积及重建时间。术后对患者进行随访,记录二期手术等待时间及并发症发生情况。结果两组下睑缺损面积差异无统计学意义(P>0.05),改良组下睑重建时间短于对照组［(62.1±7.4)min vs.(88.1±8.5)min,P<0.001］。术后随访(17.5±9.3)个月。改良组二期手术等待时间短于对照组［(11.2±3.0)d vs.(21.2±2.5)d,P<0.001］。改良组下睑退缩程度较对照组减轻(Z=-3.176,P=0.001),上睑退缩程度与对照组差异无统计学意义(t=0.351, P=0.727)。对照组2例(7.1%)出现坏死,两组均无伤口裂开、上睑下垂、睑内翻或睑外翻发生。结论 Hughes改良瓣可有效地修复大面积下睑全层缺损,操作简单且二期切开等待时间短。

关键词: 眼睑成形术, 下睑全层缺损, 大面积缺损, 眼睑重建, Hughes手术, 改良术式

Abstract: Objective To evaluate the clinical efficacy of the modified Hughes flap in repairing large full-thickness defects of the lower eyelid. Method A prospective study of 53 patients with large full-thickness defects in the lower eyelid was conducted. The patients were divided into a modified group of 25 patients and a control group of 28 patients according to the surgical method used. In the control group, the lower eyelid was repaired using an upper eyelid tarsus conjunctival flap pedicled with Muller muscle and the conjunctiva combined with a free skin graft. In the modified group, the lower eyelid was repaired using a full-thickness upper eyelid flap pedicled with the levator aponeurosis, Muller muscle and conjunctiva. The area of the lower eyelid defect, reconstruction time, time to pedicle division surgery and complication rates were evaluated. Results No significant difference in defect size was found between the control and the modified group(P>0.05). The reconstruction time of the lower eyelid in the modified group was shorter than that in the control group［(62.1±7.4)min vs.(88.1±8.5)min, P<0.001］. The average follow-up period after surgery was 17.5±9.3 months. The waiting time for second-stage surgery in the improvement group was shorter than that in the control group ［(11.2±3.0)days vs.(21.2±2.5)days, P<0.001］. The degree of lower eyelid retraction in the improved group was lower than that in the control group(Z=-3.176,P=0.001), whereas there was no statistically significant difference in the degree of upper eyelid retraction between the two groups(t=0.351, P=0.727). Two patients(7.1%)in the control group exhibited necrosis, and no instances of wound dehiscence, upper eyelid ptosis, entropion or eversion were observed. Conclusion The modified Hughes flap can effectively repair large full-thickness defects of the lower eyelid with a simple procedure and a short waiting time before pedicle division surgery.

Key words: Blepharoplasty, Full-thickness defects of the lower eyelid, Large defect, Eyelid reconstruction, Hughes surgery, Improved surgical technique

中图分类号:

R777.1

张蕾,潘叶,李家根,赵红. Hughes改良瓣修复大面积下睑全层缺损的临床效果[J]. 山东大学学报 (医学版), 2025, 63(7): 37-43.

ZHANG Lei, PAN Ye, LI Jiagen, ZHAO Hong. Clinical efficacy of modified Hughes flap for reconstruction of large full-thickness defects of the lower eyelid[J]. Journal of Shandong University (Health Sciences), 2025, 63(7): 37-43.

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