Surgical treatment of mild cicatricial ectropion

Mild scar valgus eversion due to vertical eyelid injury, laceration, inflammation, orbital osteomyelitis, or excessive skin removal during surgery in adjacent areas. Treatment of diseases: osteomyelitis valgus Indication Mild scar valgus eversion due to vertical eyelid injury, laceration, inflammation, orbital osteomyelitis, or excessive skin removal during surgery in adjacent areas. Contraindications Combined with other organ diseases, such as severe cardiovascular disease, respiratory disease, hemorrhagic disease, etc., can not tolerate anesthesia. Preoperative preparation Local infiltration anesthesia. Do a good job of pre-operative psychological care for patients. Some patients do not know much about surgery before surgery. The caregivers should be patient and meticulous in the work of patients and their families. Explain the advantages of artificial eye implants, the purpose of surgery, for The patient's complex psychological changes, various questions, nurses should patiently explain, eliminate the patient's nervousness and fear, so that patients have a sense of security and dependence, with the best mentality and surgery smoothly. Surgical procedure Vy suture 1. Incision on both sides of the scar to make a triangular flap, the base of which is to the gingival margin. The height of the flap is determined according to the degree of eversion. The angle between the incisions is generally not more than 60°, and the subcutaneous tissue is separated to reach the iliac margin. Excision of the scar tissue in the wound surface, loosening all the traction forces that can cause the eversion, and then the eyelids return to normal position. 2. Sneak separation of the subcutaneous tissue around the wound. The lower corner of the v-shaped flap is usually first sutured so that the wound edge is y-shaped. If the valgus correction is satisfactory, all skin incisions should be sutured intermittently. z forming 1. Make a skin incision along the main traction line on the scar that runs perpendicular to the gingival margin. The ends of the slit are each made into a bifurcated slit of opposite direction, the length of which reaches the vertical line in the center of the vertical scar. The angle of the incision should be determined according to how long the skin needs to be stretched. The smaller the angle, the smaller the tissue movement, the smaller the degree of skin stretching, the larger the angle, the greater the tissue movement, and the greater the degree of skin extension. Usually 45 to 60 is preferred. The angle was 45° and the length of the limb was 1.47 times the length of the incision. When the angle is 60°, the skin elongation rate is increased by 1.73 times. An angle of less than 30° and an angle of more than 90° have no clinical significance. The former can not alleviate the contraction of scar due to the narrow flap, and the latter is not easy to interleave the positions of the two flaps. 2. Remove the scar tissue in the soft tissue, sneak away the subcutaneous tissue around the wound edge, interlace the two flaps, and then return to the normal position, and suture the skin wound edge intermittently. Fricke translocation flap correction 1. Cut the skin from the edge of the iliac crest 2mm parallel to the skin, remove the scars on the skin and under the skin, scar tissue, and loosen all traction forces. Sneak separation of the surrounding tissue of the wound edge, and then the eyelids return to normal position. If the eye has more scars, it is recommended to use sutures. If the eyelids are everted and there is an elongation phenomenon, a wedge-shaped resection can be performed on the sacral margin or the missing part of the tarsal plate to restore the normal size of the eyelid. The skin defect was repaired and a horizontal incision was made on the side of the defect wound. The patient had an upper scar valgus, which was more than the upper iliac crest flap. Before the flap was cut, it was marked with gentian violet, and the range should be 1/4 of the skin defect and the shape was consistent. 2. Separate the flap and the subcutaneous tissue around the wound edge, and transfer the flap to the defect of the eyelid skin defect. Note that the pedicle should not be twisted, and should be flat without tension. Interspersed skin intermittently. 3. For the case of lower scar valgus, the pedicle flap can be cut from the upper or lower side of the iliac crest.