Frontalis muscle flap

It is suitable for patients with poor upper levator muscle function (muscle strength of upper levator levator is less than 4mm) and complete frontal muscle function. Treating diseases: eye diseases Indication It is suitable for patients with poor upper levator muscle function (muscle strength of upper levator levator is less than 4mm) and complete frontal muscle function. Preoperative preparation For the determination of the frontal muscle strength, the patient looks in front of the eye, and marks the center of the pupil at the lower edge of the eyebrow. The ruler is fixed vertically at the mark, and the patient lifts the eyebrow and the number of millimeters moved on the scale represents The momentum of the frontal muscles. The mobility of the adult frontal muscles is about 10 to 15 mm. Surgical procedure Frontal muscle spasm 1. Cut the skin, the orbicularis oculi muscle to the tarsal plate according to the double-twist line, and remove the orbicularis muscle below the incision to fully expose the tarsal plate. Separate and sneak up between the skin and the orbicularis muscle to 1.5~2.0cm above the upper edge of the eyebrow. When crossing the eyebrow, pay attention to avoid damage to the eyebrow hair follicle. 2. Separate and sneak up in the orbicularis muscle and the iliac crest, and close the periosteum over the superior iliac crest, further separating on the surface of the frontal bone, ranging from 1.5 to 2.0 cm above the upper edge of the eyebrow. 3. Lift the skin with the eyelid hook, and cut the muscle layer horizontally under the upper edge of the iliac crest and the frontal muscle and the orbicularis muscle fibers. The upper lip of the muscle layer incision is clamped by the shaping jaw, and the frontal muscle and its fascia are cut longitudinally in the middle 1/3, the outer middle 1/3 junction of the eyebrow. The adult frontal muscle flap is 2 to 2.5 cm wide and 1.5 to 2.0 cm long. The child's frontal muscle flap is 1.5 to 2.0 cm wide and 1.0 to 1.5 cm long. Care should be taken during surgery to avoid damage to the supraorbital nerves and blood vessels. Fully oppressive to stop bleeding. 4. The frontal muscle flap is pulled through the gap between the orbicularis oculi muscle and the iliac crest, and pulled downward to protrude from the surface of the tarsal plate. If the patient has a unilateral ptosis, the position of the upper iliac crest is restored to 1 mm above the iliac crest of the healthy side. If the patient has a bilateral ptosis, the upper iliac crest is placed 3 mm above the upper edge of the pupil. 5. Pull the frontal muscle flap down, restore the normal tension, make a 3-needle sacral fixed suture, make the frontal muscle flap fixed at the center of the tarsal plate, remove the excess part, and make a 5-needle skin sac fixed suture. Close the skin incision. The lower suture is pulled and fixed to the forehead skin with tape. Lifting of the frontal muscle flap 1. Cut the skin, the orbicularis oculi muscle to the tarsal plate according to the position of the iliac crest, and remove the orbicularis muscle below the incision. Separate and sneak along the face of the seesaw to expose the septum. 2. Cut the septum horizontally 2 mm above the upper edge of the iliac crest, gently press the eyeball, hold the protruding fat with a vascular clamp, cut and cauterize the cutting edge, and put the stump back. Push the eyebrows up, push the eyebrows to the upper edge of the eyebrows, and follow the eyelids of the eyelids. Make the skin incision about 2cm long and cut the muscle layer below it. 3. Stalking between the skin and the frontal muscle, width 2.0 to 2.5 cm, depth 2.0 ~ 2.5 cm. 4. Use a straight cut on the upper 2mm of the sacral incision, in the upper lip of the muscle layer under the eyebrow, from the bottom to the frontal muscle incision, about 1.5 ~ 2.0cm long. Another vertical oblique incision was made at the lateral side of the incision at 2.0 to 2.5 cm, which was about 1.5 to 2.0 cm long, so that the frontal muscle flap was pedicled. Fully oppressive to stop bleeding. The sacral incision in the upper edge of the iliac crest extends into the curved shear, and extends along the iliac crest to the superior iliac crest. A sacral incision is made along the iliac crest at the attachment of the septum, and the width can be smoothly passed through the frontal muscle flap. 5. The frontal muscle flap is inserted into the iliac crest by the incision in the upper edge of the iliac crest, and protrudes into the sacral incision at the upper edge of the iliac crest. Pull the frontal muscle flap down, return to normal tension, and place the upper jaw in the surgical design position. Fix the frontal muscle flap to the middle of the tarsal plate to check the surgical effect. If there is any inappropriateness, adjust the frontal muscle flap to fix the suture. position. Excision of excess muscle tissue. Make a 5-needle skin splint to fix the suture to close the skin incision, and suture the skin incision under the eyebrow. The lower suture is pulled and fixed to the forehead skin with tape.