Midline Forehead Flap for Coverage of Exposed Exenterated Orbital Wall after Radiotherapy

前額中線皮瓣覆蓋經眼眶剜除與放射線治療術後之眼眶骨暴露

王甯加(Ning-Chia Wang) ； 蔡悅如(Yueh-Ju Tsai) ； 楊富容(Fu-Rung Yang) ； 馬俐(Lih Ma)

《中華民國眼科醫學會雜誌》 48卷4期 (2009/12) Pp. 574-578

https://doi.org/10.30048/ACTASOS.200912.0039

摘要

目的：報告一位經眼眶剜除與放射線治療術後眼眶骨暴露之病患，成功以前額中線皮瓣治療。
方法：病歷報告。
結果：一位79歲的女性患有右眼瞼和結膜的黑色素瘤。因蔓延眼眶所以於1993年9月施行眼眶剜除術，傷口以肉牙組織自然癒合後也於1994年3月接受了放射線療法。手術後7個月（1994年4月），下外眼眶部產生組織發炎導致骨暴露且有膿液分泌物。細菌培養出金黃色葡萄球菌，我們使用局部抗生素治療(Vancomycin 50mg/cc, lgtt, q1h)，骨暴露的情況也因此改善。往後10年間，反覆發生3次的組織糜爛且眼眶骨暴露（分別於1998年7月、2001年3月及2003年7月）。為了根治組織反覆糜爛與骨暴露，我們於2003年8月執行前額中線皮瓣以兩階段手術覆蓋修補。在後續的67個月的迫蹤沒有組織壞死或者骨頭暴露的現象。
結論：利用前額力皮瓣覆蓋眼眶骨暴露，不但可以改善傷口的癒合，於美觀上也有不錯的效果。

並列摘要

Purpose: To report a case of exposed exenterated orbital wall after radiotherapy successfully managed by the midline forehead flap.
Method: A case report.
Result: A 79-year-old female presented with melanoma of the right eyelid and conjunctiva with extension to the orbit. Exenteration was performed and the wound healed by spontaneous granulation. The patient also received postoperative radiotherapy. Seven months after surgery, the patient developed an episode of bone exposure with purulent discharge at the inferior lateral wall of the right orbit. The pathogen was Staphylococcus aureus. Topical fortified antibiotic agents (Vancomycin 50mg/cc, 1gtt, q1h) were prescribed for treatment and bone exposure was improved. However, the patient experienced another three recurrences of erosion with bone exposure at the same area over the next 10-year period. To solve the recurrent erosion with bone exposure, we decided to perform midline forehead flap (MFF) covering in a two-stage operation. No recurrence of tissue necrosis or bone exposure was found during the 67-month follow-up.
Conclusion: The use of midline forehead flap to cover the exposed exenterated orbital wall after radiotherapy improved not only the wound healing, but also the aesthetic result.

並列關鍵字

Midline forehead flap ； bone exposure ； exenteration ； radiotherapy