背景:视力丧失和其他眼部缺陷是眼睑烧伤后遗症的一个问题。这通常从眼睑挛缩发展为瘢痕性外翻和眼睑。如果不及时治疗,这些可能导致暴露性角膜炎,溃疡,感染,穿孔,和视力丧失。在眼睑全层烧伤的情况下,需要释放和移植。然而,关于眼睑烧伤手术治疗结果的研究很少,尽管担心永久性眼部损伤或视力丧失。该研究的目的是描述14年来单个中心烧伤眼睑重建的并发症发生率。
方法:在2009年4月至2023年2月期间,对所有持续眼睑烧伤并需要重建的患者进行了回顾性队列研究。医疗记录来自患者的图表。收集的数据包括人口统计,病史,损伤类型,手术指征,执行的程序,和并发症。
结果:901例烧伤相关损伤需要整形手术重建的患者中,共有14例患者和25个眼睑进行了眼睑重建。这些患者进行了54次眼睑手术,平均随访时间为13.1±17.1个月。患者为71%的男性和29%的女性,平均年龄为45.1±15.6岁。在53.7%(n=29)的病例中,同时重建上下眼睑是必要的。仅上下眼睑的重建占较小的百分比(25.9%和20.4%,分别)。平均而言,患者接受3.9±3.5眼睑手术。总并发症发生率为53.7%(n=29)。最常见的并发症是外翻(42.6%,n=23)。其他并发症包括眼外伤(25.9%,n=14),眼球(24.1%,n=13),局部感染(7.4%,n=4),和移植物损失(5.6%,n=3)。
结论:眶周烧伤是一项重大挑战,可能需要复杂的手术干预。全层皮肤移植仍然是眼睑烧伤患者的护理标准。然而,外翻的发生率很高,可能需要再次手术。检查成功的眼睑烧伤手术条件的进一步研究可以为患者在烧伤治疗期间何时可以从眼睑重建中受益提供指导。
BACKGROUND: Loss of vision and other ocular defects are a concern with eyelid burn sequelae. This most commonly progresses from eyelid contracture to cicatricial ectropion and
lagophthalmos. When left untreated, these may lead to exposure keratitis, ulceration, infection, perforation, and loss of vision. In the case of full-thickness eyelid burns, release and grafting are required. However, there is a paucity of studies on outcomes in eyelid burn surgery treatment, despite concern for permanent ocular damage or loss of vision. The aim of the study is to describe the complication rates in burn eyelid reconstruction at a single center for 14 years.
METHODS: A retrospective cohort study was performed of all patients who had sustained eyelid burns and required reconstruction between April 2009 and February 2023. Medical records were obtained from patients\' charts. Collected data include demographics, medical history, type of injury, indication for surgery, procedure performed, and complications.
RESULTS: A total of 14 patients and 25 eyelids underwent eyelid reconstruction of the 901 total patients with burn-related injuries requiring plastic surgery reconstruction. These patients underwent 54 eyelid surgeries with a mean follow-up time of 13.1 ± 17.1 months. Patients were 71% men and 29% women, with a mean age of 45.1 ± 15.6 years. In 53.7% (n = 29) of the cases, the simultaneous reconstruction of both the upper and lower eyelids was necessary. The reconstruction of the upper and lower eyelid alone represented a smaller percentage (25.9% and 20.4%, respectively). On average, the patients received 3.9 ± 3.5 eyelid surgeries. The overall complication rate was 53.7% (n = 29). The most common complication was ectropion (42.6%, n = 23). Other complications included eye injury (25.9%, n = 14),
lagophthalmos (24.1%, n = 13), local infection (7.4%, n = 4), and graft loss (5.6%, n = 3).
CONCLUSIONS: Periorbital burns represent a major challenge that may require complex surgical intervention. Full-thickness skin graft remains the standard of care for patients with eyelid burns. However, there is a high incidence of ectropion that may require reoperation. Further studies examining the conditions of successful eyelid burn procedures may provide guidance on when patients may benefit from eyelid reconstruction during their burn treatment.