Management of acute traumatic eyelid defects

Abstract

Objective To investigate the clinical characteristics,operation techniques and keys for acute traumatic eyelid defects.Method 34 cases with traumatic eyelid defects,in which none of the wounds could be repaired by direct closure.In anterior lamella eyelid defects,moderate defects (less than 2/3 involvement) were repaired by advancement,rotation or transposition flaps,and skin grafts from posterior auricular skin and medial upper arm were used for large defects (more than 2/3) followed by tarsorrhaphies afterwards.Moderate full-thickness eyelid defects (＜ 1/2 involvement) were repaired by semicircular flaps with lateral cantholysis,while extensive full-thickness defects (＞ 1/2 involvement) were repaired layer by layer through skin flaps,preserved sclera (replacing the tarsal plate) and advanced conjunctival flaps followed by tarsorrhaphies afterwards.For those special patients with heavy systemic problem or trauma,after copious irrigation washes and through debridement the wound were covered by iodoform gauzes for secondary repair.Result 19 cases of the 25 cases with anterior lamella upper eyelid defects were repaired by various skin flaps,and recovered well.The other 6 cases repaired by skin grafts.There were 9 cases of full-thickness eyelid defects,5 cases with ＜ 1/2 involvement repaired by semicircular flaps with lateral cantholysis and recovered well,and 2 cases were repaired layer by layer through skin flaps,preserved sclera and advanced conjunctival flaps.In the remainder 2 cases,covered by iodoform gauzes there was no infection in the wound,and the eyelid were reconstructed 7 and 20 days later respectively.Conclusion The keys to successful surgery for traumatic eyelid defect are careful debridement,flexible operation skills and meticulous suture of the fragmentized tissues.Additionally,flap is always the first choice to ensure the best contour and optimal function.The special patients who couldn' t endure emergent surgery need reasonable treatment and preparation for secondary repair. Key words: Eyelid defect, traumatic ; Reconstruction