Surgical indication

Cicatricial ectropion caused by various injuries, burns and excessive skin shedding after eyelid tumor resection.

Preoperative preparation

Follow the routine preparation before external eye surgery.

anesthetize

Local infiltration anesthesia or general anesthesia (both upper and lower eyelids are everted).

Surgical procedure

1. 3 mm from eyelashes. Cut the skin parallel to the eyelid margin, reach the superficial surface of scar tissue, and separate between the skin and the dynamic scar (Figure 1-9- 1).

2. Remove all the scar tissue in the wound and under the skin until the eyelid returns to its normal position, and stop bleeding through sufficient compression. If there is arterial bleeding, 5-о silk thread can be ligated to stop bleeding (Figure 1-9-2).

3. Upper and lower eyelid margin mattress suture, * * * do three pairs of suture. After ligation, the upper and lower eyelid margins were closed (Figure 1-9-3).

4. After the donor site is disinfected, paste a wet gauze impression. Draw the peeling range with sterilized methylene blue according to the ratio of 1/4. After subcutaneous infiltration anesthesia, the skin graft was taken out by non-invasive technique. The donor site was peeled off subcutaneously and then sutured. Skin grafting can be selected from behind the ear, supraclavicular depression or inside the upper arm. If there is adipose tissue under the flap, it should be cut off (Figure l-9-4).

Sewing. To apply full-thickness skin graft to eyelid defect. If it is redundant, it should be cut off, so that the edge of the skin graft naturally meets the edge of the wound. Suture the two corners of the skin graft with No.4-0 silk thread and fix it. The suture needle distance is about 3 mm, and the needle should be inserted from the skin graft side to prevent the skin graft from moving. The interval is 2~3 stitches, and the thread end is left long for ligation and pressure dressing (Figure 1-9-5).

6. After the suture is completed, the subcutaneous hemorrhage is squeezed out, and several layers of vaseline gauze with the same size are put on the skin graft, and dry gauze is added for dressing and ligation (Figure 1-9-6).

Polizel's therapy

1. Systemic application of antibiotics for 5~7 days.

2. Binocular bandage was used for 5 days and monocular bandage for 6 days after operation. Change the dressing 6~8 days after operation. The skin graft suture was removed 10 ~ 12 days after operation. Continue to pressure bandage for 4~5 days. Eyelid margin suture can be removed 10 day after operation. The suture removal time of donor site is 8~ 10 day.

3. If the dressing has oozing, peculiar smell and purple skin, it should be checked in time and properly handled.

clinical experience

1. For severe burns, surgery should be considered when the scar turns from pink to dark after 6 months or more after injury. However, if the eyelid ectropion is serious, the eyelid closure is incomplete and the cornea is exposed, the operation can be performed in advance.

2. The lower eyelid should be transplanted with full-thickness skin graft; The upper eyelid should be transplanted with thin full-thickness skin graft.

3. Broad-spectrum antibiotic eye drops should be dripped into conjunctival sac a few days before operation; Before operation 1 day, the donor site was fully prepared, cleaned, shaved, disinfected with 75% alcohol and bandaged with sterile gauze. Strict aseptic operation during operation to prevent infection from causing failure. Observe the changes of body temperature after operation, and see if there is tenderness locally. If there is infection in the dressing change, it should be removed, and bacterial culture and drug sensitivity test should be done.

4. When removing stitches, if the skin graft is pink and closely attached to the base, it means that the skin graft is completely alive. If it is purple, it has a sense of fluctuation, suggesting that there is a hematoma under the skin graft. You can use an injection needle to suck out the accumulated blood, then apply pressure to bandage it, and there is still the possibility of survival.

5. In order to prevent and reduce the contraction of skin graft, we should fully remove the traces of subcutaneous movement.

6. If skin grafting fails, consider reoperation every 6 months.