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mắt
  Tổng quan

Nội dung  Liệu trình điều trị

 Điều trị phẫu thuật
  Xanthomatous lession: presence of fibroproliferative
connective tissue wt associated lipid-laden histiocytes.
 Xanthlasma palpebrarum: most common kinds of
xanthomatous lesions.
 Typical lesion apperance: soft, yellow plaques on the medial
Introduction aspect of the eyelids
 Middle-aged and older adults
 Women > Men
  A benign asymptomatic lesion
 Not associated with any cutaneous complication
 Treatment is often sought for cosmetic reasons

Xanthlasma
palpebrarum
 4 độ phụ thuộc vào vị trí và mức độ lan rộng của tổn thương
• (A) Độ I – tổn thương chỉ nằm ở mí trên
• (B) Độ II – tổn thương nằm ở góc mắt trong
• (C) Độ III – tổn thương nằm ở góc mắt trong cả trên và
dưới
• (D) Độ IV – tổn thương lan rộng ở cả góc trong và ngoài
của mi trên và mi dưới

Phân độ
(theo Lee & cs) *

* Lee HY, Jin US, Minn KW, Park

YO. Seoul National University
 Topical therapy
 Laser
 Surgery
Treatment
protocol
Điều trị phẫu thuật
  Zarem and Lorincz’s: superficially excises xanthelasma lesion
 Le Roux, a modified blepharoplasty -> enclosing medial canthal area
better than classic incision.
 Parkes and Waller
 using classic blepharoplasty incision to excise xanthelasma and warn against
extending the incision to include those lesions not included in the standard
flap design.
 Support serial staged excisioins that remove only 1 or 2

History xanthelasma/procedure wt minimum 2-month interval between procedures

 For isolated xanthelasma, en toto excision of soft or immature lesions,
elliptical.
 Other shape, “uncapping” removal of the cholesterol deposit in one piece ->
tension-free closure.

 Hosokawa et al,
 Using orbicularis oculi musculocutaneous flap coversing after excision of
large lesions while perserving upper-lid skin for reexcision in the case
recurrence.
 1

Ghép da

 BN đa phần lớn tuổi, kèm theo da thừa góc mắt ngoài/ sụp mi trên
 Chỉ cắt bỏ thương tổn góc trong mí mắt sẽ gây khuyết mi mắt trong 
=> Sử dụng vạt da thừa
khiến tình trạng da thừa mí ngoài lộ rõ hơn.
mí ngoài để tạo hình
 Ghép da  co kéo quanh vùng ghép
  Simple excision in conjuction with blepharoplasty.
Classic  Remaining lession: combination of simple excision and local
blepharoplasty flaps
  Là vạt tại chỗ  tương hợp hoàn toàn với vị trí khuyết
hỗng.
 Mạch máu phong phúc ổn định
 Tái tạo mi trên thường khó hơn vì:
Vạt cơ vòng mi -  Các lựa chọn vạt xung quanh hạn chế
Orbicularis oculi  Là mí động
myocutaneous  Contour
(OOMC) flap  Vai trò che phủ và bảo vệ nhãn cầu
 Lower eyelid:
 Nhiều sự lựa chọn. Chia vùng mi dưới thành 2 lớp:
da-cơ và sụn mi-niêm mạc. Đánh giá mức độ tổn
thương xâm lấn và tái tạo
 Excision of the lesion and formation of the myocutaneous flap incorporating blepharoplasty. Left right
lesion in a 58-year-old woman. Right left lesion in the same patient 

Yang, Yanqing & Sun, Jiaming & Xiong, Lingyun & Li, Qiong. (2013). Treatment of Xanthelasma Palpebrarum by Upper Eyelid Skin Flap
Incorporating Blepharoplasty. Aesthetic plastic surgery. 37. 10.1007/s00266-013-0195-0.
  Basic science: The orbicularis oculi musculocutaneous
flap
 OOMC flap was widely elevated extending through the

Korean modified whole upper eyelid with the lateral flap first along with fat
maneuver.
surgical methods
  Marking the boundary of the lesion + Design the fold incision
 Local anesthesia
 Removal of skin encompassing the xanthelasmas and the orbicularis
oculi muscle at the location of the lesion
 Incision along the existing eyelid fold was made, for the redistribution of
loose redundant skin, to meet the demand of the required fold line.
Surgical  OOMC flap was widely elevated extending through the whole upper
eyelid on the lateral flap by first priority.
technique  Medial flap and lateral flap are divided by the excision line of the lesion,
expanding apart from the traditional blepharoplasty incision line.
 Surgical
technique  Fat maneuver is conducted by opening the orbital sep- tum beneath the
orbicularis oculi muscle
 The lower flap is sutured by tarsodermal or tarso-dermo- levator fixation
with 7-0 nylon sutures at 3 points to get the desired height of the eyelid fold.
 OOMC flap is advanced to the medial direction for the lateral flap and to the
lateral direction for the medial flap, as per the requirement, to cover the
defect
 Congession
  Similarity in color and texture with the eyelid zone.
 The extent of excision for the lesion lies naturally within the
upper blepharoplasty marking.
 A horizontally lesion can be excised during the skin and muscle
incision.
 Extensively elevated flaps can handle a large defect easily

Advantages owing to the rich blood supply of the eyelid

 Easy dissecting: the plane is obvious, minimalizing bleeding in
the surgical view.
 Cosmetically postop appearance. The creation of a double
eyelid was possible for aesthetic purposes when patients with
Asian eyelids desired it.
  A vertical scar that can be remarkable
 Neo-Mongolian fold due to the elevation of the medial flap.
Pitfull  Tight tension during the first few months
 Tripple fold formation
Thank you for your attention!