OBJECTIVE The correction of ectropion of lower lid and severe infra-orbital soft tissue depression is very difficult. Former methods included simple skin graft, tubed graft, transfer of local skin flap and so on. These methods had some disadvantages, such as not enough tissue to fill the depression, too much damage done to the donor area and operation in stages required. METHODS After investigation on the anatomy of temporal region, designed the following method. Combined transfer of the galea aponeurotica and temporal fascia was used to repair severe infra-orbital soft tissue depression and ectropion of lower lid in 6 cases. RESULTS It was discovered that the combined transfer of the galea aponeurotica and temporal fascia was rich in blood circulation because they received blood supply from parietal branch of superficial temporal artery and could be transferred to a distance as far as 15-18 cm. The skin graft used to cover the fascia usually resulted in good survival. This technique was used in 6 cases with good success. CONCLUSION This method had some merits such as the tissue flap had good blood supply, little damage done to the donor area, good correction of the severe depression, good appearance following correction, operation done under local anesthesia and completed in one-stage operation.
【摘要】 目的 观察应用不同手术方法矫正麻风麻痹性下睑外翻的疗效。 方法 2006年10月-2009年11月，共收治麻风麻痹性下睑外翻68例115眼，根据患者下睑外翻程度和局部专科情况，分别采用颞肌移位+阔筋膜移位悬吊固定术（Johnson法），改良颞肌移位术，下睑板缩短外眦韧带悬吊固定术，眼轮匝肌岛状皮瓣，眼轮匝肌悬吊固定术以及丝线悬吊固定术矫正眼睑外翻。 结果 68例115眼成功率98.9%，手术后由于下睑外翻导致的各种合并症明显好转。随访观察4～11个月所有患者术后效果良好，无复发。 结论 麻风麻痹性下睑外翻的手术治疗应根据患者的不同情况选择合适的手术方法，才能达到最佳的矫正效果。【Abstract】Objective To evaluate the clinical effect of different surgical methods to correct lower eyelid paralytic ectropion. Methods From October 2006 to November 2009, 68 cases (115 eyes) with lower eyelid paralytic ectropion induced by leprosy were treated in this department.According to the degree and local circumstance of different patients, some patients underwent temporalis muscle transfer (TMT) with the Johnson’s procedure, some patients underwent modified temporalis muscle transfer, and some patients underwent orbicularis oculi muscle island flap or uplifting the lower eyelids with orbicularis oculi muscle, silk, lateral canthal tendon. Results The achievement rate of 68 cases (115 eyes) was 98.9%.The complications resulted from lower eyelid ectropion were obviously improved.All the patients got good results followed up for 4 months to 11 months after operation and no recurrence was found. Conclusion To achieve the best effect of correcting lower eyelid paralytic ectropion, it is the key point to choose the suitable method according to the level and local circumstance.