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2023年7月 第38卷 第7期11
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风筝皮瓣及旋转皮瓣在修复眉眼前层缺损中的应用

Application of kite flap and rotary flap in repairing eye/eyebrow anterior layer defect

来源期刊： 眼科学报 | 2023年4月 第38卷 第4期： 312-320 发布时间：2023-04-18 收稿时间：2023/4/19 14:43:39 阅读量：3497
作者：
王斌,
杨文娟,
许丹丹,
关键词：
风筝皮瓣旋转皮瓣皮瓣转移推进皮瓣眉缺损眼睑皮肤缺损眉重建眼睑重建修复重建
kite flap rotary flap Flap transfer Propulsion flap Eyebrow defect Eyelid skin defect Eyebrow reconstruction Eyelid reconstruction Repair and reconstruction
DOI：
10.12419/j.issn.1000-4432.2023.04.02
目的：探讨风筝皮瓣及旋转皮瓣在眼外伤或良性肿物切除术后造成眉眼前层缺损的疗效，评价其预后、修复效果以及美学评分改变。方法：收集2018年5月至2020年5月34例眉/眼外伤或因良性肿物行手术切除患者，其眉眼前层缺损最大直径不超过眼长度1/2，根据创面缺损位置、范围，设计沿皮纹方向的缺损邻接部位局部风筝皮瓣及旋转皮瓣，推进滑行局部转移皮瓣向缺损区移位一期修复缺损。随访6个月观察术后皮瓣愈合情况、缺损的修复效果、并发症、患者满意度，比较手术前后美学评分。结果：所有皮瓣全部成活，切口均为I期甲级愈合，局部皮瓣的皮肤色泽、厚薄、毛发情况、质地以及眉毛走行分布与未手术侧基本一致，皮瓣创周器官组织形态无明显改变，皮瓣上眉毛生长良好，手术切口隐蔽在肌肤纹路处、瘢痕增生不鲜明，所有患者无需再次手术。缺损部无臃肿，双侧连续性以及对称性良好，无眉眼变形、倒睫、睑内外翻、上睑下垂等出现，眉/眼组织形态美观、功能良好。患者对手术效果比较满意。患者术后1d及1、3、6个月的美学评分分别为(73.50±7.79)、(76.97±6.84)、(82.21±6.11)和(87.06±6.07)分，均高于术前的(50.59±9.71)分，比较差异均有统计学意义(均P<0.05)。结论：应用风筝皮瓣及旋转皮瓣I期修复眉/眼皮肤软组织缺损，可较好地恢复眉/眼形态和功能，患者对缺损修复效果满意度高，能取得较高的美学评分，操作简单易行，效果可靠，无明显并发症。
Objective:To investigate the therapeutic efect of kite fap and rotary fap on superfcial tissue defect of eyebrow/eye caused by eyebrow/eye trauma or benign tumor resection, and to evaluate the prognosis, repair effect and aesthetic score changes. Methods: A total of 34 cases of eyebrow/eye trauma or benign tumors who underwent surgical resection were collected between May 2018 and May 2020. Te maximum defect diameter was not more than 1/2 of the length of eyebrow/eye. According to the location and scope of the defect, local kite flaps and rotary flaps were designed at the adjacent along the dermatoglyphic direction, and the sliding local transfer faps were promoted to the defect area to repair the eyebrow and eyelid ocular defects in stage one. Follow up for 6 months to observe the fap healing, defect repair efect, complications, patient satisfaction and aesthetic score. Results:All the skin faps survived, and the wound healing was Grade I A. The skin color, thickness, hair condition, texture and eyebrow shape distribution of the local skin faps were basically similar to the non-surgical side. Tere was no obvious change in the tissue morphology around the faps. Te eyebrows on the skin faps grew well, and the surgical incision was concealed in the skin lines with no distinct scar hyperplasia. All patients did not need operation again. Te defects were not swollen, bilateral continuity and symmetry were good, without eyebrow and eye deformation, without trichiasis, entropion or ptosis, etc. Te eyelid/eyebrow were beautiful and functional. The patients were satisfied with the surgical results. The aesthetic scores of patients at diferent postoperative monitoring times (1 day, 1 month, 3 months and 6 months) afer surgery were (73.50 ± 7.79), (76.97 ± 6.84), (82.21 ± 6.11) and (87.06 ± 6.07) points respectively, which were significantly higher than the preoperative scores (50.59 ± 9.71) points, and the diferences were statistically signifcant (P<0.05). Conclusion: Te kite fap and rotary fap can be used to repair the eyebrow/eye skin and sof tissue defects in Phase I, which can restore the shape and function of the eyebrow/eye well. Te patients are satisfed with the efect of the defect repair, and can obtain a higher aesthetic score. Te operation is simple and easy, the efect is reliable, and there was no obvious complications.
    眉眼位于面部显要位置，是人类面部重要器官与美学标志，双侧的完整对称对容貌影响巨大[1]。眉、眼睑外伤及良性肿物对容貌的影响很大，手术切除后易造成组织缺损，若强行拉拢缝合会导致眉眼严重畸形，如眉下垂、睑内外翻、成角畸形及闭合不全等[2]。因此对术后创面修复要求高，若缺损处理不当，既影响美观及眉眼功能，同时也伤害患者心身健康[3]。为了彻底切除病变，良好地恢复眉眼外观、形态及功能，同时避免发生并发症， 2018 年以来笔者团队根据眉眼皮肤缺损的大小、原因、位置采用风筝皮瓣及旋转皮瓣进行I期修复，取得满意的疗效，现报告如下。

1 对象与方法

1.1 研究对象   

    收集2018年至2020年在本院就诊的34例眉、眼睑外伤或良性肿物切除术后皮肤组织缺损修复患者，其中男14例、女20例，年龄6个月~75岁，中位年龄(38.5)岁，平均为(40.37±20.71)岁。因眉外伤或良性肿物切除致眉缺损者7例，均为单侧眉缺损；眼睑外伤或良性肿物切除致眼睑缺损者27例，其中上睑14例、内眦3例、下睑8例、外眦2例。创面长度均小于眉/眼睑长度的1/2。缺损范围最大为18mm×31mm，最小为7mm×9mm。纳入标准：1)诊断为眉眼外伤或良性肿物，2)临床资料完整，3)均签署知情同意书，4)无严重精神疾病；排除标准：1)患者不能随诊配合治疗，2)严重全身疾病，3)有严重精神疾病，影响随诊。所有患者及其家属均积极配合医护人员的相关治疗操作并能随访检查，均无严重精神疾病。该研究经河南大学淮河医院伦理委员会审核通过2023209。

1.2 手术方法

    患者取仰卧位，设计切除范围(良性肿物边缘外1mm)，切口按照眉眼部皮纹方向设计，用记号笔标记切除范围及皮瓣形态，常规手术区消毒铺巾，使用局部麻醉药(1%盐酸利多卡因注射液中加入1∶200000盐酸肾上腺素注射液)进行局部注射，达到浸润麻醉效果后，按划线切除良性肿物，行风筝皮瓣及旋转皮瓣手术。
    皮瓣设计制作：根据眉/眼缺损的大小、部位、形状及范围，按邻近皮肤纹理走向设计标记单侧或双侧风筝皮瓣和(或)旋转皮瓣，部位隐蔽且组织活动性良好。沿划线切开全层皮肤，在真皮下充分游离皮瓣两边及缺损周围组织，形成带蒂单侧或双侧皮瓣，牵拉皮瓣覆盖创面。根据张力情况，有时需掀起皮瓣前端基底部，一般不超过皮瓣长度1/3避免皮瓣血供不足。先行分层减张法修复继发缺损深部组织(6-0可吸收缝线，完整修复肌层，可靠减张缝合皮下组织)，避免出现凹陷畸形；缺损处6-0可吸收缝线中间固定1针皮瓣组织，使创面达到无张力覆盖，皮下组织均匀间断减张缝合，修剪皮瓣边角组织，直至美观平整；最后皮肤组织7-0缝线间断缝合，术毕用妥布霉素地塞米松眼膏涂抹创口，适当加压包扎，冷敷24h。术后24h换药，敞开伤口，每日1次使用0.3%妥布霉素滴眼液，擦洗创口，观察皮瓣情况，若出现不良反应，及时采取治疗措施，6~7d拆线，切口有张力者延迟2~3 d拆线，之后可辅助使用抗瘢痕凝胶涂抹伤口，持续3~6个月。

1.3 观察指标 

    评估术后眉/眼缺损修复情况，观察形态，详细记录术后不良反应的发生情况。手术前后(包括术前与术后1 d及1、3、6个月)进行美学评分。记录术后6个月时疗效评价情况和患者对手术效果的满意度结果，计算有效率与患者满意率。
    自行制备美学评分量表，让患者对容貌进行自主评分，满分为100分，100分代表对自己容貌极其满意、自我感觉非常美。不良反应包括感染、坏死、挛缩、凹陷、瘢痕、局部血肿等。
    疗效评价标准分为：治愈指患者创口痊愈，色泽与周围一致，切口瘢痕不明显，眉眼外形自然、功能良好；有效指患者创口痊愈，色泽与周围接近，切口轻度瘢痕增生，眉眼外形尚可、功能良好；无效指患者创口愈合不佳或病情未改变甚至加重，外形不佳或明显瘢痕增生。有效率=(治愈例数+有效例数)/总例数×100%。
    患者对手术效果的满意度调查结果分为特别满意、基本满意和不满意。患者满意率=(特别满意例数+基本满意例数)/总例数×100%。

1.4 统计学处理

    所有数据使用SPSS23.0进行统计学分析，计量资料用 (x±s)表示，治疗前、后1 d、1、3、6个月美学评分采用重复测量数据方差分析，两两比较采用Dunnett’s T3检验，计数资料用例(%)表示，以P<0.05为差异具有统计学意义。

2 结果

2.1 一般情况

    本组34例眉眼部分缺损患者，一期行风筝皮瓣及旋转皮瓣修复，所有皮瓣全部存活，达到100.00%的成活率，色泽与周围组织相似或接近，无任何“危象”发生(如皮瓣下积血、感染、坏死、皮瓣移位皱缩)，伤口均I期愈合，手术瘢痕不明显、隐蔽，均未行二次手术。随访6个月，良性肿物均无复发，眉眼外观美容形态功能良好，睑裂开启闭合、瞬目功能正常，眉抬举、皱眉功能正常，眉毛分布均匀，切口瘢痕隐蔽，未出现睑内外翻、上睑下垂、暴露性角膜炎、成角畸形、眉毛脱失等。双侧眉眼外形对称(眉毛高度、长度、走向、粗细；睑裂大小、高度、形态、弧度，内外眦形态、眦角大小)。

2.2 患者治愈情况

    治愈27例，有效7例，有效率为100%。

2.3 患者满意度

    对修复疗效特别满意27例，基本满意7例，无不满意患者，满意率达100%。

2.4 美学评分分析

    患者在术后不同时间(1d和1、3、6个月)的美学评分均明显提高，患者自觉容貌美观性提高，与术前比较差异均有统计学意义(P均<0.05)，且于术后1个月起美学评分明显提高，结果详见表1、图1，典型病例介绍见表2。图2展示了内眦色素痣切除术后情况；图3展示了上睑色素痣切除术后情况；图4展示了眼部不同部位的缺损修复示意图。

1 34 例眉眼前层缺损患者在手术前后的美学评分变化
Table 1 Changes in aesthetic scores before and after operation in 34 patients with anterior eyebrow/eye layer defects

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图1 34例眉眼前层缺损患者在手术前后的美学评分变化
Figure 1 Changes in aesthetic scores before and after operation in 34 patients with anterior eyebrow/eye layer defects

表 2 典型病例介绍
Table 2 Introduction of typical cases

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图2 右眼内眦色素痣切除术皮肤缺损修补
Figure 2 Skin defect repair after removal of pigmented nevus on the right eye inner canthus
男性患儿，6月龄，自出生发现右眼内眦色素痣，随年龄增长逐渐增大。(A)右眼内眦色素痣术前照片，缺损大小为7mm×9mm；(B)标记切除范围及设计风筝皮瓣及旋转皮瓣；(C、D)术后1 d闭眼与睁眼，内眦形态良好，无睑内外翻及内眦变形；(E)术后1个月，内眦形态良好，切口处稍红，瘢痕不明显；(F)术后3个月，内眦形态良好，瘢痕不明显，两侧对称。
The boy was 6 months old, found right inner canthus pigmentation nevus at birth with gradually increasing with age (A) Preoperative photo of right inner canthus pigmented nevus, defect size 7 mm× 9 mm； (B)  Mark the excision range and design kite flap and rotating flap; (C,D) Closed and opened eyes 1 day postoperation, with good inner canthus morphology and no internal and external eyelid inversion or inner canthus deformation; (E)  One month after surgery, the inner canthus was in good shape, the incision was slightly red, and the scars were not obvious; (F) Three months after surgery, the inner canthus was in good shape, no obvious scars and bilateral symmetry.

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图3 左眼上睑外侧色素痣切除术皮肤缺损修补
Figure 3 Repair of skin defect after removal of lateral upper eyelid pigment nevus in left eye
(A)左眼上睑色素痣术前照片，缺损大小为12 mm×10 mm；(B)术中切除范围及风筝皮瓣设计；(C)术后即刻，上睑形态良好、眉毛形态良好，无睑内外翻，无上睑形态改变，无眉眼部的变形；(D)术后1周拆线，上睑、眉毛形态良好，切口处稍红，瘢痕位于眉下，不明显。
(A) Preoperative photos of pigmented nevus on the upper eyelid of the left eye, with a defect size of 12 mm×10 mm； (B) Intraoperative resection range and kite flap design; (C) Immediately postoperation, the upper eyelid and eyebrows were in good shape, there was no internal and external eyelid inversion, no changes in upper eyelid shape, and no deformation of the eyebrow and eyelid; (D) the sutures were removed 1 week postoperation, and the upper eyelid and eyebrow were in good shape. The incision was slightly red, and the scar was not obvious which located under the eyebrow.

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图4 风筝皮瓣在眼部应用示意图
Figure 4 Schematic diagram of kite flap application to eye
黑色圆圈代表组织缺损部位，红色线条表示皮瓣设计，ABCDabcd均表示设计皮瓣移位对合处。
(A)眉毛头端缺损修复，采用单侧风筝皮瓣，使尾端向头端伸展推进，保持眉头形态，将acb向眉头移位修补缺损；(B)眉毛中间部位缺损修复，采用双风筝皮瓣，切口隐藏于眉内及眉毛上下缘，注意术中切口顺应毛囊方向，避免破坏毛囊，将A与a推进重叠至同一位置，B与b推进重叠至同一位置；(C)眉毛尾端缺损修复，采用双风筝皮瓣，术中注意眉毛形态及保护毛囊，皮瓣推进与图(B)相似；(D)上睑内上方缺损修复，采用单风筝皮瓣，切口位于眉下与缺损边缘，将皮瓣向鼻侧推进使d与D重合，abC向鼻侧推进修补缺损，颞侧对位缝合；(E)上睑中央较大缺损，使用改良双风筝皮瓣，采用眉下及重睑切口，往中央推进，使纵向切口无张力，做工字形双蒂风筝皮瓣，使A区域与B区域均向中央推进修复缺损；(F)上睑颞上方缺损修复，采用颞侧风筝皮瓣进行修复，切口隐藏于眉下，皮瓣推进与图(D)相似；(G)上睑内下方缺损修复，采用不对称双风筝皮瓣修复，注意上睑形态及睫毛走向，避免睑内外翻、倒睫，沿重睑线设计皮瓣，使A与a推进重叠，修补缺损；(H)上睑中央中等大小缺损，采用双风筝皮瓣，切口放置于重睑切口处，皮瓣推进与图(G)相似；(I)上睑颞下方缺损修复，采用不对称双风筝皮瓣修复，术中注意眼睑形态，避免发生睑内外翻、角膜暴露等，皮瓣推进与图(G)相似；( J)内眦下方缺损修复，采用鼻旋转皮瓣联合下睑风筝皮瓣进行修复，术中做到无张力缝合，保持内眦形态不变形，ABC为风筝皮瓣，abc为旋转皮瓣，将A与a，B与b推进重叠修复缺损，将c移至原a处，修补旋转皮瓣继发缺损；(K)内眦上方缺损修复，采用鼻旋转皮瓣联合上睑风筝皮瓣进行修复，皮瓣推进与图( J)相似；(L)外眦缺损修复采用改良双风筝皮瓣进行修复，术中注意保持外眦形态，内层肌肉固定于外眦部眶骨膜，保持外眦的形态，充分游离abc皮瓣，将C移至原外眦处，内层固定于外眦部眶骨膜，ab分别移至上下睑缺损的AB处，即a与A，b与B重叠。
The black circle represents the tissue defect site, the red line represents the flap design, and ABCabc represent the location where the design flap is shifted and overlapped (A) Repair of eyebrow tip defect using a unilateral kite flap, extending and advancing the tail end towards the head end, maintaining the shape of the eyebrow, and shifting the acb to the eyebrow tip to repair the defect; (B) Double kite flaps were used to repair the defect in the middle part of the eyebrow, and the incision was hidden inside the eyebrow and the upper and lower eyebrow edges. Attention was paid to the incision direction during the operation following the hair follicle to avoid damaging the hair follicle. A and a while B and b were pushed and overlapped to the same position; (C) Repair of eyebrow tail defect using a double kite flap, paying attention to eyebrow morphology and protecting hair  follicles during the operation. The flap advancement is similar to Figure (B); (D) Single kite skin flap was used to repair the upper inner eyelid defect. The incision was located under the eyebrow and the defect edge. The flap was advanced to the nasal side to make d coincide with D, and abC was advanced to the nasal side to repair the defect, with temporal alignment suturing; (E)Repair the large defect in the center of the upper eyelid using the improved double kite flap, and the incision was made under the eyebrow and double-fold eyelid line, advance the flap to the defect center to make the longitudinal incision tensionless. The I-shaped double-pedicled kite flap was used to push the area A and area B to the center to repair the defect; (F) Repair of the upper eyelid and upper temporal defect using a temporal kite flap, the incision was hidden beneath the eyebrow, and the flap was similar to figure (D);(G) The defects in the lower and inner upper eyelid were repaired by asymmetric double kite flaps. Paying attention to the shape of the upper eyelid and the direction of the eyelashes, to avoid eyelid inversion and trichiasis. Skin flaps were designed along the double eyelid line to overlap A and a to repair the defects. (H) Medium size defect in the center upper eyelid was repaired by using double kite flap. The incision was placed at the double eyelid incision, and the flap was similar to figure (G); (I) The lower temporal defect of the upper eyelid was repaired by asymmetric double kite flap. During the operation, attention was paid to the eyelid morphology to avoid eyelid inversion and corneal exposure, etc. The flap advance was similar to figure (G). ( J) Repair of the defect below the inner canthus using a nasal rotating flap combined with a lower eyelid kite flap. During the surgery, tension free suturing was achieved to maintain the shape of the inner canthus without deformation. ABC was kite flap and abc was rotary flap. A and a, B and b were pushed to overlap to repair the defect, and c was moved to the original location a to repair the secondary defect of the rotary flap. (K) The upper inner canthus defect was repaired by nasal rotation flap combined with upper eyelid kite flap. The flap advancement was similar to Figure ( J). (L) Improved double kite-flap was used to repair the defects of the outer canthus. During the operation, attention was paid to maintaining the shape of the outer canthus. The inner muscle was fixed in the orbital periostium of the outer canthus to maintain the shape of the outer canthus. The abc flap is fully free, and C is moved to the original outer canthus. The inner layer is fixed to the orbital periosteum of the outer canthus, and a b were moved to A B of the upper and lower eyelid defects respectively, whereas a overlaps with A and b overlaps with B.

3 讨论

    眼眉为眶上缘处横弧形分布的一束毛发，可以阻隔额头汗液向下流，防止进入睑裂。眼睑处在人类面部黄金点位置，具有眼球保护屏障、维持睑板功能、稳定泪膜、引流泪液、维持眼睛形态及面部外观等功能。眉眼是面部五官重要的外貌器官，是中国美学艺术上“三庭五眼”的重要标志。眉眼周表情肌活动丰富，对于传达情意、表达喜怒哀乐情感有着重要的特殊作用。两侧眉眼位置、外形完整镜像对称，在面部占比适合，对颜面部容貌美学有重要意义。若眉眼部存在良性肿物、畸形、瘢痕、色素痣及缺损，会妨碍面部正常表情运动与美观，严重者会导致生理功能障碍，对患者的心理健康造成一定程度的不良影响[1]。
    目前随着人们生活水平提高，患者对容貌要求越来越高，有眉眼睑部肿物、瘢痕及色素痣等治疗的需求越来越多。手术切除可以达到去除病灶目的，然而眉眼部位及结构特殊，缺损后很难找到与之在色泽、皮肤纹理、质地、厚薄、毛发方向及解剖组织上均相匹配的组织。如果修复不恰当，引发局部单位解剖结构牵拉变形，影响形象美观及功能，缺损重建是一种比较复杂的手术。创面修复重建的目标是闭合伤口、恢复眉眼功能并尽可能获得满意的外观[4]，如何修复才能达到功能与外观美容重建的完美结合，这是极具挑战性难题。局部邻位皮瓣特征是带有全层皮肤和蒂组织，组织色泽、质地、毛发方向、厚度及局部解剖方面与缺损创面相似性较高[5]，具有良好形态及功能再造价值，因此可作为修复眉眼中等大小皮肤缺损修复的最佳材料[6]。对于眉、上下眼睑、外眦部缺损，笔者团队使用“风筝”皮瓣修复，内眦、鼻背及瘢痕组织缺损的修复采用风筝皮瓣及旋转皮瓣，获得了良好疗效，达到形与美及功能修复双重效果。
    本研究病例有外伤、良性肿物、色素痣、瘢痕等，缺损分布范围广。本研究中采用“风筝”皮瓣根据组织缺损大小采用单蒂及双蒂两种类型，若接近睑缘的创面，常采用单蒂皮瓣，若较大缺损修复需使用双蒂“风筝”皮瓣，最大能修复眼睑一半缺口。本研究中术后全部患者皮瓣均正常良好存活，存活率高达100%，血供情况可靠良好，未出现移位、感染、坏死、挛缩、创口明显瘢痕形成等不良现象，无二次手术患者。术后半年随访期内，美学评分均优于术前，满意率100%。术后1d与1个月美学评分相近，表明术后1个月内伤口美观状态处于恢复期，伤口瘢痕组织变化不明显；术后1~6个月美学评分不断提高，表面伤口外观处于不断美观状态。术后局部平整，眼睑、眉毛及眦角弧度自然，外形美容良好，功能正常，双侧基本对称，瘢痕隐蔽不易发现。表明利用“风筝”皮瓣与旋转皮瓣进行眉眼部组织缺口修复，能够达到患者满意，美学与功能修复双重要求[7]。
    风筝皮瓣是由岛状皮肤和皮下蒂组成的三角形皮瓣，由皮下肌肉蒂组织提供血运，主要作用是组织延长和移位。旋转皮瓣是沿一轴线旋转达到覆盖创面，用于需跨越的特殊部位结构修复[8]。这两种皮瓣用于眉眼部中等大小缺损的一期修复有如下
优点：①“风筝”皮瓣带有全层皮肤及皮下组织，以眼轮匝肌或颞筋膜组织为蒂[9]，血运丰富可靠，手术转移操作方法简单灵活，术后术区平整、无臃肿，无继发“猫耳”畸形，有效利用剩余皮肤进行创面修复[10-11]；②皮瓣缩小眼睑垂直宽度增加长度，减少垂直方向张力，增加皮瓣水平长度，恢复眉眼水平方向的连续性；③皮瓣切口与眉眼走向一致，瘢痕隐藏在睑缘、重睑线及眉毛处；④供区皮瓣质地、色泽、厚度、毛发疏密度与生长走形与缺损区相匹配，术后皮瓣柔软耐磨、弹性良好、抗感染力强、无明显瘢痕挛缩变形[12-13]。体会如下：①“双风筝”皮瓣能使较大面积缺损修复覆盖，造成继发损伤创口较大，为避免局部缝合过程中出现张力过大，需充分潜行剥离皮下滑动间隙，同时切实结合肌层定位缝合与皮下减张缝合[9]，再缝合皮肤层，同时密切监视皮瓣血运，在紧张感大的缝线处延迟2~3d拆线。为防止瘢痕增生，在拆线后应使用防瘢痕制剂。②眉眼部位皮瓣制作时，注意切缝顺应眼眉的生长趋势，为保存毛囊、毛发及人体真皮下血管网，在肌肉上方进行潜行的钝性分离。③眉尾、眉眼间和内外眦特殊交叉部位设计时，充分合理利用周围组织进行设计，选择尺寸大小、形状均恰当相宜的皮瓣，皮瓣选择松弛部位，一般皮瓣形态选择三角形，又或者设计为其他形态来适应缺损部形态，切口方向顺应眼睑肌肤纹路(如睑缘、重睑线、鱼尾纹等)。④在修剪皮瓣时要保持基底宽度，推进时应在无张力下完成，既保证了皮瓣血运的充分，也要防止眼睑变形及“猫耳”现象的出现。⑤游离可加强了皮瓣移动性，注意长宽比例，以免血运障碍，剥离时重视解剖分层，一般采用钝性分离，注意保护眶上、滑车上神经血管束、穿支血管。⑥“风筝”皮瓣的长度为缺损直径的1.5~2.0倍[14]；旋转皮瓣的设计选择应进行准确精细的设计，大小尺寸合适，达到皮瓣即可将缺损伤口创面充分完整覆盖包裹，继发缺损亦能完全封闭，同时并不牵扯导致眦角、眼睑及眉间畸形，影响正常面容形态；⑦术中认真细致止血，术后适度选择加压包扎，以免形成血肿与瘀斑。
    综上所述，“风筝”皮瓣与旋转转移皮瓣一期修复眉/眼部中等大小缺损存活率高，不易出现挛缩现象，手术简单易行，成功率高，患者满意度高，美学评分较高，达到功能与形态的完美统一，是眉/眼部中等缺损修复的最佳方法，值得临床推广应用。

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Zhao Y, Bai R, Hao HY, et al. Effect of bicularis oculi muscle kite flap combined with double eyelid surgery on the reconstruction of blepharoblepharis xanthotomy [ J]. Chinese Aesthetic Medicine, 2022, 31(9): 112-114.赵瑜, 白蓉, 郝红艳, 等. 眼轮匝肌风筝皮瓣联合重睑术修复睑 黄瘤切除术后缺损的效果评价[ J]. 中国美容医学, 2022, 31(9): 112-114.
Zhao Y, Bai R, Hao HY, et al. Effect of bicularis oculi muscle kite flap combined with double eyelid surgery on the reconstruction of blepharoblepharis xanthotomy [ J]. Chinese Aesthetic Medicine, 2022, 31(9): 112-114.
11、谌宏运, 曹国秀, 朱伟, 等. 局部皮瓣修复面部基底细胞癌30例回 顾性分析[ J]. 临床皮肤科杂志, 2021, 50(10): 625-629.
Chen HY, Cao GX, Zhu W, et al. Retrospective analysis of 30 cases of facial basal cell carcinoma repaired by local skin flap [ J]. Chin J Clinical Dermatology, 2021, 50(10): 625-629.谌宏运, 曹国秀, 朱伟, 等. 局部皮瓣修复面部基底细胞癌30例回 顾性分析[ J]. 临床皮肤科杂志, 2021, 50(10): 625-629.
Chen HY, Cao GX, Zhu W, et al. Retrospective analysis of 30 cases of facial basal cell carcinoma repaired by local skin flap [ J]. Chin J Clinical Dermatology, 2021, 50(10): 625-629.
12、陈琢琦, 陈思博, 陈伟华. 相似形改良旋转皮瓣的临床应用体会 [ J]. 中国美容整形外科杂志, 2022, 33(3): 136-138, 146.
Chen ZQ, Chen SB, Chen WH. Chinese Journal of Aesthetic Plastic Surgery, 2022, 33(3): 136-138, 146.陈琢琦, 陈思博, 陈伟华. 相似形改良旋转皮瓣的临床应用体会 [ J]. 中国美容整形外科杂志, 2022, 33(3): 136-138, 146.
Chen ZQ, Chen SB, Chen WH. Chinese Journal of Aesthetic Plastic Surgery, 2022, 33(3): 136-138, 146.
13、Ma Y, Zhou X, Yuan Z, et al. The kite flap for reconstructing tumour excision wounds in the middle and lower face: a retrospective study[ J]. J Wound Care, 2020, 29(10): 562-566.Ma Y, Zhou X, Yuan Z, et al. The kite flap for reconstructing tumour excision wounds in the middle and lower face: a retrospective study[ J]. J Wound Care, 2020, 29(10): 562-566.
14、杨志勇, 乔丽, 方帆, 等. V-Y推进皮瓣修复眉缺损[ J]. 中国麻风皮 肤病杂志, 2015, 31(12): 733-735.
Yang ZY, Qiao L, Fang Fn, et al. Repair of eyebrow defect with V-Y advancing flap [ J]. Chin J Leprosy Dermatology, 2015, 31(12): 733- 735.杨志勇, 乔丽, 方帆, 等. V-Y推进皮瓣修复眉缺损[ J]. 中国麻风皮 肤病杂志, 2015, 31(12): 733-735.
Yang ZY, Qiao L, Fang Fn, et al. Repair of eyebrow defect with V-Y advancing flap [ J]. Chin J Leprosy Dermatology, 2015, 31(12): 733- 735.
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