Use of Gore-Tex Sling in Brow Suspension Procedure

Gore-Tex於前額懸吊術之使用

王惠珠(Hwei-Zu Wang) ； 張丞賢(Cheng-Hsien Chang) ； 蘇明揚(Ming-Yang Su) ； 郭松齡(Song-Lin Guo)

《The Kaohsiung Journal of Medical Sciences》 10卷3期 (1994/03) Pp. 131-137

https://doi.org/10.6452/KJMS.199403.0131

摘要

眼瞼下垂之前額懸吊術有各種不同的材質可供使用。我們嘗試以人工血管Gore-Tex ( expanded polytetrafluoroethylene，ePTFE ) 做為前額懸吊術的懸吊材料。共有11位病人( 15側眼瞼）手術：包括10眼（8位）先天性眼瞼下垂；1眼創傷性眼瞼下垂（18歲男性）; 4眼（2位71歲、53歲）年老病人。所有病人提眼肌功能皆幾乎全無，且上眼瞼遮住視軸。手術方式在先天性眼瞼下垂10眼以Fox五角形法，其餘三位（五眼）採Crawford變更方式，將兩股吊帶在兩個三角形接觸點相互交叉，並將吊帶縫至眼瞼板上。術後病人追蹤平均9.1月（2月至16月）o
手術過程眼瞼高度及形狀調整方便、容易。唯前期中6眼裹有4眼其在最上方打結之處產生肉芽腫瘤，其中一病例合併結膜穹窿肉芽腫瘤及Gore-Tex切出結膜。有鑑於此我們將原寬3mm之懸吊帶改為Zmm寬，且以60線縫合雙股吊帶避免吊帶打結來減少打結處之體積。經此改良之後肉芽腫瘤減少為後9眼中僅2眼產生。
以Gore-Tex人工血管材質來做眼瞼下垂之前額懸吊術，取材方便、操作容易、術後美觀性皆甚佳。短期追蹤15眼僅1眼因肉芽腫瘤合併感染而稍有滑落。唯前額懸吊帶打結處之肉芽腫瘤產生較多，雖經改良後此後遺症稍有減少。但仍需更長時問及更多病人的追蹤。

並列摘要

A variety of materials have been employed for brow suspension surgery for ptosis. Gore-Tex (expanded polytetrafluoroethylene ePTFE) has been used as vascular prosthesis. We have used cylinder Gore-Tex in brow suspension surgery for 15 ptotic eyelids (11 patients), including 10 eyes (8 patients) of congenital ptosis, 1 eye of traumatic ptosis in a young male, and 4 eyes (2 patients) of myogenic ptosis in elderly patients. All of the eyelids had minimal or absent levator muscle function, and drooped to cover the visual axes. The surgical technique for the 10 congenital ptotic eyelids was a modified Fox¡¦s method. The remaining 5 adult eyelids were operated by a modified Crawford¡¦s method, with interlocking of the two suspension bands at the lower apex of each triangle and direct suturing of the bands to the tarsal plate.
The use of Gore-Tex in brow suspension makes it easy to adjust the height and contour of the operated eyelids. Patients were followed-up from 2 to 16 months (average 9.1 months) postoperatively. The only complication was granuloma formation at the most upper knot area in 5 patients (6 eyelids), one of which also had granuloma at the ipsilateral fornix with the Gore-Tex band cutting through the conjunctiva. One eyelid drooped due to knot granuloma and infection.
After knot granuloma occurred in the early cases, in which we had used 3 mm-wide band of Gore-Tex for surgery, we reduced the band width to 2 mm, and minimized the size of the band¡¦s knots by suturing rather than tying them in the later 9 eyelids. Granuloma formation was reduced to 2 eyelids.
To employ cylinder Gore-Tex in brow suspension for ptosis surgery has the advantage of easy accessibility and handling, a satisfactory postoperative cosmetic result, and barely any slippage in a short-term follow-up. But knot granuloma formation is frequent. Although the incidence reduced after our modification, more research with a large sample is necessary as well as a longer time of follow-up to verify its effect.

並列關鍵字

Polytetrafluoroethylene (PTFE) ； Brow suspension ； Ptosis