Posterior Auricular Artery Flap with Cartilage for Reconstruction in a Case of Lower Eyelid Melanoma

使用後耳動脈皮瓣與軟骨重建右下眼瞼黑色素瘤

羅琪(Chi Lo) ； 李建智(Jian-Jr Lee) ； 陳宏基(Hung-Chi Chen)

《臺灣整形外科醫學會雜誌》 29卷4期 (2020/12) Pp. 296-304

摘要

Background: The eyelids are vital in the spread of tears, lubrication of the corneal surface, and protection of the eye from dust and foreign bodies. A disruption in the eyelid anatomy can be harmful to the integrity of the cornea and ocular surface. As it is a delicate structure, reconstruction of periorbital defects is a great challenge for plastic surgeons, regardless of whether it is caused by trauma or malignancy. Aim and Objectives: Our aim is to successfully reconstruct the periorbital structure in patients with wide lesions. Moreover, we tried to preserve the function of eyes while maintaining good aesthetic results. Materials and Methods: A 38-year-old woman without any systemic disease presented with a progressively growing pigmented lesion (2 mm × 2 mm) over the last one year, which was located at the lateral third of the right lower eyelid. At first she underwent excision of the lesion at another hospital, however, the histopathology was suggestive of nodular type melanoma with unclear margins. In our hospital, she underwent wide excision and consecutive reconstruction with a free posterior auricular artery flap with a piece of cartilage for the right lower eyelid and a mucosal graft from the palate for the lower eyelid conjunctiva. Results: We successfully reconstructed the right lower eyelid with a free posterior auricular artery flap and a mucosal graft from the palate. After four years, the operated site healed completely without recurrence. The patient had good function of the right eyelid, and also showed very good aesthetic results. Conclusion: The posterior auricular artery flap can carry cartilage for reconstruction of the tarsal plate. A mucosa graft from palate can cover the conjunctival surface. It is a delicate surgery that can achieve good functional and aesthetic results.

關鍵字

lower eyelid reconstruction ； tarsal plate reconstruction ； periorbital defect ； free flap reconstruction

並列摘要

背景：眼瞼在促進淚水擴散、濕潤角膜表面及保護眼睛不受塵土及異物的侵襲方面有非常重要的功能。眼瞼的受損可能影響角膜及眼球表面，進一步造成眼睛功能的受損。眼周是非常精細的構造，因此對於一位整型外科醫師而言，不論是因為創傷或是惡性所造成的眼周結構受損，在重建方面都是極富挑戰的領域。目的及目標：在進行眼周廣泛性切除手術的病人中以游離皮瓣達成重建，並進一步地保持眼睛完整的功能性和美觀。材料及方法：一位38歲女性無特殊過去病史，於就診前一年注意到右下眼瞼外側三分之一處有一2毫米乘2毫米大小的深色病灶。經外院切除手術後病理報告為惡性黑色素瘤但是邊界並未切除乾淨。經檢查無其他病灶及遠端轉移的狀況下轉診至本院整形外科行手術治療。經廣泛性切除後以游離耳後動脈皮瓣附帶軟骨及黏膜移植進行右下眼瞼的重建。結果：在這位病人身上，因其他重建方式皆有不適合之處，病患在經歷廣泛性的切除手術後因為大範圍的下眼瞼、眼瞼板及結膜缺損，以游離耳後動脈皮瓣及黏膜移植進行了右下眼瞼的重建。結論：我們使用游離耳後動脈皮瓣攜帶一片軟骨做為重建眼瞼板之用，而由上顎取下的粘膜移植物做為結膜重建之用。此方式的好處為：1.在較大範圍切除惡性黑色素瘤之後可避免復發；2.可一次完成重建；3.避免日後皮瓣攣縮；4.保存良好的外觀。在四年的觀察期中，病患並未有黑色素瘤復發的狀況，並且右眼重建的眼瞼及結膜並未發生攣縮，完整地保存了右眼的功能和外觀。