RU2248193C1 - Surgical method for treating the cases of cicatricial eversion of inferior eyelid - Google Patents

Abstract

FIELD: medicine.

SUBSTANCE: method involves introducing allotransplant for making carcass eyelid plastic repair using foot derma having trapezoid shape, between musculocutaneous and chondroconjunctival plates of the inferior eyelid. It is fixed with allotendinous threads using external and internal eyelid ligaments or using external and internal orbit edge periosteum. The inferior fornix is built by placing mattress suture with allotendinous threads along orbit edge through allotransplant and fixing the suture on its surface. The sutures are placed uniformly allover the inferior fornix length. The allotransplant is covered with muscle flap on pedicle cut-off in inferior orbit region. The flap is attached to the allotransplant on lower eyelid edge and the arisen inferior eyelid skin defect is substituted with free skin graft. Skin graft can be taken from internal arm surface.

EFFECT: enhanced effectiveness in repairing eyelid; prevented recidivation.

2 cl, 8 dwg

Description

The present invention relates to medicine, namely to ophthalmology, and can be used for surgical treatment of cicatricial eversion of the lower eyelid. Analogs of the proposed invention are well-known surgical methods for eliminating cicatricial eversion of the lower eyelid, based on a combination of skin grafting methods (free skin graft, skin graft on the leg from the upper eyelid, from the temple or cheek) with partial wedge-shaped resection of the eyelid and chondroplasty (Zaykova M.V. Plastic Ophthalmosurgery, M .: Medicine, 1980, 69-89). However, with cicatricial eversion of the lower eyelids, especially after burns, not always known methods of surgical intervention give a good stable cosmetic and functional result. Relapses are not excluded. The prototype of the invention is a method of supporting plasty of the lower eyelid with an allograft to close the defects of the base of the lower eyelid, which is a dermis with subcutaneous tissue of the foot, in order to prevent its further deformation and displacement. (Muldashev E.R., Salikhov A.Yu., Bulatov R.T. Copyright certificate SU, No. 1524883, class A 61 F 9/00). The disadvantage of this method of supporting plastics of the lower eyelid is that this method is not effective to eliminate the eversion of the lower eyelid and to prevent its recurrence.

The technical result of the invention is the elimination of eversion of the lower eyelid, the restoration of its normal anatomy and the prevention of recurrence of eversion.

The technical result is achieved by simulating a trapezoidal allograft for skeleton eyelid repair, which is the dermis of the foot, and inserted between the conjunctival cartilage and musculoskeletal plates of the lower eyelid, is fixed to the outer and inner ligaments of the eyelids or periosteum of the outer and inner edges of the orbit filaments, then the lower arch of the conjunctiva is formed with the help of mattress sutures with allotendinous threads, which are passed through the lower arch of the conjunctiva along the edge of the orbit through the allot the implant is fixed on its surface, three such sutures are applied uniformly along the entire length of the lower arch, the allograft is covered with a muscle flap on a leg cut in the lower orbital region, which is fixed to it along the edge of the lower eyelid, and the resulting defect in the skin of the lower eyelid is replaced by a full-layer skin flap, taken, for example, from the inner surface of the shoulder.

The method of surgical treatment of cicatricial eversion of the lower eyelid is illustrated by figures 1, 2, 3, 4, 5, 6, 7, 8.

A method of surgical treatment of cicatricial eversion of the lower eyelid is as follows. A horizontal incision is made of the skin 1, departing from the ciliary edge by 4-5 mm along the entire length of the lower eyelid (Fig. 1). The incision continues to the cartilage, thus separating the musculocutaneous 2 and conjunctival-cartilaginous 3 plates of the eyelid to the edge of the orbit (figure 2). An allograft 4 for frame eyelid plasty (TU 42-2-5 37-2002) is inserted into the pocket formed between the lower eyelid plates, which is fixed with knotted sutures with the help of allotissue threads (TU 9431-001-27701282-2002) to the inner and outer ligaments of the eyelids 5 (figure 3) or to the periosteum of the outer and inner edges of the orbit 6 (figure 4).

The lower arch is formed with the help of mattress sutures with allograft threads 7, which are conducted through the lower arch of the conjunctiva along the edge of the orbit through the allograft and are fixed on its surface. Three such seams are applied evenly along the entire length of the lower arch (Fig. 5). Thus, the eyelid is given a natural anatomical position and the eversion is eliminated. Then the allograft is covered with a muscle flap on the leg 8, cut in the lower orbital region (Fig.6), which is fixed to the allograft along the edge of the lower eyelid 9 (Fig.7). On top of this flap, a skin defect of the lower eyelid is replaced by a free full-layer skin flap 10 (Fig. 8), for example, from the inner surface of the shoulder.

The difference of the present invention from the prototype is that, firstly, the allograft from the dermis of the foot is not used to close the defects of the base of the lower eyelid, but to create the skeleton of the lower eyelid by strengthening the deformed cartilage of the eyelid cartilage, and secondly, the allograft is not placed on the lower the wall of the orbit, and directly onto the deformed own cartilage of the eyelid, thirdly, to give the eyelid a natural position, the allograft is fixed to the inner and outer ligaments of the eyelids or periosteum in fourth and fourth, to strengthen the effect of the operation and prevent the recurrence of eversion by allotissuous threads, the lower arch is formed, fifth, the allograft is covered with a muscle flap cut out in the lower orbital region on the leg, which provides engraftment of a free skin patch on it sixthly, to close the resulting skin defect, free skin plastic is used.

Example 1. Patient M. 16 years. Diagnosis - OS - A consequence of a thermochemical burn. OS - Cicatricial eversion of the lower eyelid III century. Lagophthalmus - 5 mm.

The following operation was performed: Autoalloplastic elimination of the eversion of the lower eyelid. Operation progress: Horizontal incision of the skin of the lower eyelid 1 (Fig. 1), 5 mm from the ciliary edge. The incision is continued to the cartilage, separating the musculocutaneous flap of the 2nd century from the cartilage 3 (figure 2). An allograft for frame surgery of the lower eyelid 4 (Fig. 2) is inserted into the formed pocket, which is fixed with two knotted sutures with the help of allo-tendon threads to the periosteum of the inner and outer edges of the orbit 6 (Fig. 4). Produced the formation of the lower arch with three mattress sutures 7 using allotissue threads (figure 5). Then, in the lower orbital region, a muscle flap was cut out on leg 8 (Fig. 6), which was laid on top of an allograft for frame eyelid repair and fixed to it with knotted sutures along the edge of the eyelid 9 (Fig. 7). Autoskin was taken from the inner surface of the shoulder. The edges of the skin wound of the inner surface of the shoulder are adapted by subcutaneous sutures with the help of allotendinous threads, the continuous suture is applied to the skin of the inner surface of the shoulder. The resulting defect in the skin of the lower eyelid is replaced by a free skin flap from the inner surface of the shoulder 10 (Fig. 8). The patient was discharged on the 8th day after surgery. Long-term follow-up 3 years. The lower eyelid is adjacent to the eyeball. There is no Lagophthalmos.

Example 2. Patient K., 43. Diagnosis - OS - Post-traumatic cicatricial eversion of the lower eyelid, II century. Cicatricial deformity of the skin of the lower eyelid. Lagophthalmus 5 mm. The following operation was performed: Autoalloplastic elimination of the eversion of the lower eyelid. Operation progress: Horizontal incision of the skin 1 (Fig. 1), departing from the ciliary edge by 4 mm along the entire length of the lower eyelid. The incision is continued to the cartilage, separating the soft tissue from the cartilage. A scar-altered area of the skin of the lower eyelid with a width of 5 mm and a length of 20 mm was excised. In the resulting pocket between the musculoskeletal flap 2 and cartilage 3, an allograft for skeleton repair of the eyelids 4 (Fig. 2) is inserted, which is fixed to the outer and inner ligaments of the eyelids 5 (Fig. 3) using allotissue threads. Produced the formation of the lower arch with three mattress sutures 7 using allotissue threads (figure 3). Then, in the lower orbital region, a muscle flap was cut on the leg 8 (Fig.6), which is laid on top of the allograft and fixed to it with knotted sutures along the edge of the eyelid 9 (Fig.7). Autoskin was taken from the inner surface of the shoulder. The edges of the skin wound of the inner surface of the shoulder are adapted by subcutaneous sutures with the help of allotendinous threads, and the skin has a continuous suture. The resulting defect in the skin of the lower eyelid is replaced by a free skin flap from the inner surface of the shoulder 10 (Fig. 8). The patient was discharged on the 8th day after surgery.

Long-term follow-up 3 years. The lower eyelid is adjacent to the eyeball. There is no Lagophthalmos.

In total, according to the proposed technique, 17 patients were operated on.

Claims (2)

1. A method of surgical treatment of cicatricial eversion of the lower eyelid, characterized in that the allograft for frame eyelid plasty, made of the dermis of the foot and having a trapezoidal shape, is inserted between the musculoskeletal and conjunctival-cartilaginous plates of the lower eyelid, and fixed with allo-tendon threads for the external and internal ligaments eyelid or periosteum of the inner and outer edges of the orbit, form the lower arch by applying allograft threads of mattress sutures passing along the edge of the orbit through the allograft with fixation and its surface, the seams are applied uniformly over the entire length of the lower dome, and then coated with allograft muscle flap on the leg, a cut in the area nizhneorbitalnoy, allograft fixed flap to the edge of the lower eyelid and the resulting substituted lower eyelid skin defect free skin graft. 2. The method according to claim 1, characterized in that they use a skin flap taken from the inner surface of the shoulder.

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