Repair of lower eyelid defect with cheek rotation flap

Ambrozoua et al. reported in 1993 that squat repair can be divided into three categories: 70% of defects can be used in the Mustard method: nasal septal mucosa cartilage instead of palpebral conjunctiva, tarsal plate, repaired residual skin with rotating buccal flap; for 95% The operation of orbital defect can be divided into stage II: stage I surgical transfer of the epiphyseal flap and posterior flap, phase II reoperation for the incision of the inferior flap; for 100% of the full layer defect with nasal septum mucosa The cartilage flap repairs the tarsal plate and the conjunctiva, and the skin defect is repaired by the bridge flap. Treatment of diseases: congenital eyelid defects Indication The buccal rotation flap method for the treatment of hernia defect is applicable to: 1. Large vertical nasal defect. 2. Because eye disease is not suitable for people with long-term closure (such as glaucoma, acute corneal disease or children with amblyopia, etc.). 3. Patients who cannot undergo secondary surgery. 4. Those who have subtotal or total defects. The shortcoming of this operation is that the tension of the tendon is insufficient, and the lateral sag of the lower jaw and the valgus valgus can occur in the late stage. Therefore, it is only used in a few special cases. Surgical procedure 1. The defect is trimmed into a triangle, the nasal side of the triangle is nearly vertical, and the vertical length is equal to the defect width. 2. The incision of the buccal iliac crest tissue, starting from the lateral iliac crest to the upper part of the iliac crest (flat eyebrows or above the level of the eyebrows), to the front of the hairline, the creases between the front and the cheeks are vertically downwards. Ear lobe. 3. Peel the deep layer under the skin until the flap completely covers the defect. Finely stop bleeding when peeling, and pay attention to avoid damage to the facial nerve branch. 4. Take 2cm × 1.5cm nasal mucosa cartilage flap (when total defect), suture the nasal mucosa cartilage flap with the 8-0 line and the deep tissue of the defect. If the allogeneic sclera or autologous cartilage is used as the lining of the flap, the mucosal surface is absent, and it takes about 6 weeks for the epithelium to form naturally. Stimulation during this period can be alleviated with antibiotic eye ointment. 5. The lower edge of the mucosa and the lower condylar conjunctiva were sutured with a 5-0 absorbable thread. 6. The buccal metastases were moved to the nasal defect area, and the medial malleolus was fixed through the buccal dermal ligament with the 4-0 silk thread to fix the posterior or medial periosteum of the medial malleolus ligament. The external iliac crest is sutured with the dermis of the buccal flap and the periosteum of the iliac crest. 7. Make a few sutures deep in the upper end of the buccal flap to act as an upward force. 8. Use 7-0 silk thread for suture stitching and remove excess skin. 9. The upper and lower jaws are temporarily sutured for 5d stitching.