Repair Of Cicatricial Ectropion Research Articles

Laser therapy in the treatment of cicatricial ectropion.

The objective of this study was to investigate the clinical effects of laser therapy in treating cicatricial ectropion. Seven patients with cicatricial ectropion were entered into this clinical study. The ectropions were pretreated with the 595-nm pulsed dye laser if the scar color was red. If there was no red, the UltraPulse fractional CO2 laser was used and parameters were adapted according to the height of scar. MEBT/MEBO was used after laser treatment for wound healing. The degree of ectropion was measured for changes before and after treatment, and the scars were evaluated for changes in melanin, height, vascularity, and pliability using the Vancouver Scar Scale (VSS) before and after treatment. All seven patients with cicatricial ectropion entered into this protocol were completely corrected after 1-2 treatment sessions. The total VSS score, as well as the score for melanin and pliability in 7 patients, showed a decrease following the treatments, and this was statistically significant (P<0.05). The scores for height and vascularity showed a decrease following the treatments, but there was no significant difference by statistical analysis (P≥0.05). There were no adverse reactions reported. The treatment of cicatricial ectropion with laser therapy can not only correct the ectropion, but also improve the scars in the treatment area. Compared with the traditional repair of cicatricial ectropion, the use of fractional CO2 laser provides surgical precision and the advantage of a timely treatment without the need to wait for the scar to stabilize.

Anterior lamellar deficit ectropion management.

To report the outcomes of using a modified Bick's procedure (MBP) combined with a monopedicle myocutaneous flap (MMCF) or full-thickness skin grafting (FTSG) to correct lower eyelid cicatricial ectropion. A retrospective case-note review of patients undergoing cicatricial ectropion repair between 2012 and 2016 was undertaken. Patient demographics, clinical features, the type of surgery, and outcomes were analysed. Twenty-four eyelids of 21 treated patients (17 males; 81%) with lower eyelid cicatricial ectropion were identified. They presented at an average age of 79.8 years (median 78; range 58-92). The commonest symptom was epiphora (15 eyelids; 63%), 12 patients (50%) experienced intermittent irritation, and 2(8%) had mucoid discharge. The aetiology included actinic cicatricial ectropion with midface descent (n = 19, 79%), previous tumour resection (n = 3, 13%), trauma (n = 1) and other previous eyelid surgery (n = 1). At a mean follow-up period of 15.3 months (median 6; range 6-52), 22 eyelids (92%) had anatomical success with good cosmesis and two eyelids (8%) had mild residual punctal ectropion. Twenty-one patients (87%) experienced functional success. Comparing the outcomes of MBP + FTSG versus MBP + MMCF, there was no statically significant difference in terms of anatomical (p = 0.48) and functional (p = 1.0) success rates. No cases of failure or recurrence were noted during the follow-up period. Anterior lamellar deficit ectropion occurs in the absence of overt scarring. It is crucial to fully address both the horizontal laxity and the anterior lamellar deficit associated with such ectropion to minimise the risks of early failure and recurrence. MBP combined with FTSG or MMCF is a safe and effective treatment for such 'cicatricial ectropion' and has a low early recurrence rate.

Cicatricial Ectropion Repair for Dermatologic Surgeons.

Cicatricial ectropion occurs when tension of a scar below the eye has sufficient downward pull to evert the lower eyelid. There are many surgical techniques to repair cicatricial ectropion. To review the published literature on the repair of cicatricial ectropion, review relevant anatomy, and review surgical considerations for patients with cicatricial ectropion from the perspective of a dermatologic surgeon. A search of PubMed was conducted to identify articles on cicatricial ectropion repair through December 1, 2017. Articles were individually reviewed for applicability to dermatologic surgery. Forty-one articles were reviewed. Many articles report significant differences in outcomes when comparing 1 cicatricial ectropion repair technique to another; however, 1 single surgical approach has not been shown to be superior to the rest for most patients. There is a lack of consensus among the literature about the optimal approach to repairing cicatricial ectropion. The selection of surgical technique will vary depending on several factors including the lateral or medial extent of the ectropion, the degree of scarring and tissue density of potential donor sites for a skin flap, and the severity of lid laxity.

Simultaneous Lateral Tarsal Strip and Medial Spindle Procedures for Cicatricial Ectropion.

Lateral tarsal strip (LTS) and medial spindle (MS) procedures are surgical techniques used to address cicatricial ectropion. To evaluate the clinical characteristics and efficacy of simultaneous LTS and MS procedures for repair of cicatricial ectropion occurring after dermatologic surgeries. A retrospective review of all cases of symptomatic, cicatricial, lateral, and medial punctal ectropion in 1 author's (C.C.) practice over 2 years was performed. Those resulting from dermatologic surgical procedures and repaired with simultaneous LTS and MS procedures were included. Fifty-six tumors involving the lower eyelid were considered highly at risk and treated with Mohs micrographic surgery and reconstruction in the senior author's practice during the review period, resulting in 3 (5.3%) cases of cicatricial ectropion. Five additional cases resulted from Mohs surgery and 7 resulted from excisions of pigmented lesions, all performed by other surgeons. One postoperative complication (6.7%) of undercorrection required reoperation, with initial surgical success rate being 93.3% and overall surgical success being 100% after the single reoperation. Simultaneous LTS and MS are useful procedures for dermatologic surgeons yielding high surgical success and a low complication rate for correction of medial and lateral cicatricial ectropion with punctal eversion.

Cicatricial ectropion surgery: a prospective study of long‐term symptom control, patient satisfaction and anatomical success

Cicatricial ectropion repair is effective and has a low complication rate. To evaluate the effectiveness and long-term functional outcomes of surgical repair of lower lid cicatricial ectropion. Prospective consecutive case series. Forty-four consecutive operations for cicatricial ectropion repair. Consecutive cases of cicatricial ectropion repair completed during 2007-2011 in Waikato Hospital and Hamilton Eye Clinic, New Zealand, were enrolled in the study following formal ethics approval. Ectropion repair was completed using inferior retractor repositioning, horizontal lid tightening and full-thickness skin grafting. Patient-reported symptoms and satisfaction, ectropion recurrence and punctal ectropion. Forty-four eyes of 40 patients (30 males and 10 female) were included in the study. The average age at surgery was 75 years. Watering and poor appearance were the most common presenting symptoms. Postoperative follow-up was 1-6 years (mean = 4 years). There were no major perioperative complications, one patient developed trichiasis postoperatively. There were five reoperations (11%) during the study period. Two patients underwent medial spindle procedures for symptomatic medial ectropion and three patients required additional horizontal lid tightening. Seventy percent of patients reported satisfaction with their long-term results despite the partial recurrence of symptoms in 45%. Ectropion recurrence in <1 year occurred in three patients. In this series, satisfactory appearance and symptom control were reported by 68% of patients at long-term follow-up. Preoperative marked ectropion with marked lid laxity is associated with early treatment failure and may be regarded as a relative contraindication to surgical correction with this technique. Punctal ectropion is an unreliable indicator of functional success.

A pilot study to evaluate the efficacy of fibrin glue in attaching full thickness skin graft in repair of cicatricial ectropion

Background: Traditionally, sutures are used to attach skin graft. Periocular skin reconstruction is peculiar in respect of constant movement of the graft bed due to lid movements. This study was aimed at evaluating the use of fibrin glue in skin graft for cicatricial ectropion.Methods: This was prospective, non-randomized, interventional study. Total 10 patients with cicatricial ectropion were recruited. After dissection of scar, skin defect was covered with full thickness post auricular graft. Fibrin glue used to attach the graft over host bed. Bolster tied and bandage applied. Patients were evaluated for graft stability, opposition of graft host junction and graft uptake.Results: The mean age was 30.9 years. Patients were divided into three groups i.e. 20-30 years, 30-40 years and 40-50 years. There were 05 patients (50%) in first group, 03 patients (30%) in second group and 02 patients (20%) in third group. Majority (90%) were male. Following injury 70% patients reported between 1-3 years. Grade 3 ectropion was most common (60%). Average duration of surgery was 79.3 min (standard deviation of 14.15 min). Horizontal dimensions of graft, 32 mm maximum and 26 mm minimum (average 29 mm). Vertical dimensions of graft, 18 mm maximum and 12 mm minimum (average 15 mm). Graft uptake was complete in all cases. No cases of graft infection or necrosis. However, 03 patients had residual ectropion.Conclusions: Use of fibrin glue in attaching full thickness skin graft is an effective and safe technique with good uptake and stable graft host junction.

Use of Cyanoacrylate Glue Casting for Stabilization of Periocular Skin Grafts and Flaps.

To examine a novel technique for periocular skin graft and flap stabilization using cyanoacrylate glue applied to the host bed around the perimeter of the graft or flap to create an immobile cast in the immediate postoperative period to promote successful graft take and stable anatomic position. Retrospective review was performed of a single surgeon's patients who underwent periocular skin graft or flap between August 1, 2011, and February 29, 2016, in which cyanoacrylate glue was applied postoperatively for graft stabilization. Data examined included indication for procedure, location and size of graft, postoperative complications, and length of follow up postoperatively. Of 164 cases reviewed, 9 cases were identified in which cyanoacrylate glue was used as the sole means of graft or flap stabilization. Indications for surgery included repair of cicatricial ectropion (3 cases) and repair of Mohs defect status after excision of basal or squamous cell carcinoma (6 cases). All cases involved reformation of the lower eyelid. Five cases employed full-thickness skin grafts and 4 cases employed adjacent tissue rearrangement. Size of defect repaired ranged from 8 mm to 35 mm when largest diameter was measured. Complications included mild residual ectropion or mild punctal ectropion in 2 patients who was asymptomatic and did not require further surgery. No cases were complicated by hematoma, infection, or graft necrosis. Cyanoacrylate glue can be used to successfully stabilize skin grafts and flaps in the immediate postoperative period.

Free transplantation of autogenous palmaris longus tendon in the repair of cicatricial ectropion of lower eyelid

Treatment of cicatricial lower eyelid ectropion is often difficult and requires surgical intervention. Numerous techniques have been developed over the years to treat the cicatricial lower eyelid ectropion. This article describes an effective surgical technique using the free transplantation of autogenous palmaris longus tendon in the repair of cicatricial lower eyelid ectropion. The operation was performed with the patient under local anaesthesia. After the contracture of the lower eyelid skin or conjunctiva had been thoroughly released, a palmaris longus tendon graft was obtained through small transverse incisions along the non-dominant forearm. The graft is suspended between the medial canthal ligament and lateral orbital rim with proper tension. Then a local skin flap was transferred to cover the wound at the lower eyelid. In this study, 15 patients were treated using autogenous palmaris longus tendon between December 2008 and October 2012. At the 9–18 months of follow-up assessment, there were no major complications reported with any of the cases, and all have achieved good function and satisfactory appearance of the lower eyelid. However, five patients (33%) still had lagophthalmos, but it was in remission. In conclusion, free transplantation of autogenous palmaris longus tendon in the repair of cicatricial ectropion of the lower eyelid is an effective procedure for cicatricial ectropion, the functional and cosmetic results were satisfactory, the recurrence rate is low. Especially for the moderate and severe ectropion this method is a good choice.

Viability of full‐thickness skin grafts used for correction of cicatricial ectropion of lower eyelid in previously irradiated field in the periocular region

The purpose of this study was to evaluate the viability of skin grafts used for correction of cicatricial ectropion resulting from previous ablative surgery and radiotherapy for head and neck cancer and to report overall outcomes of cicatricial ectropion repair. This is a retrospective, noncomparative case series of all consecutive patients with head and neck cancer who had been exposed to high-dose radiation therapy in their periocular region and had surgical correction of their lower eyelid cicatricial ectropion through placement of a full-thickness skin graft and a lower eyelid tightening procedure by the same surgeon. The primary outcome measure was skin graft viability. Secondary outcome measures comprised postoperative complications, the overall outcome of ectropion repair as judged by improvement in symptoms of exposure keratopathy, and dependence on lubricating eye drops and ointments, as well as cosmetic improvement measured through a grading scale based on the degree of inferior scleral show and/or tarsal conjunctival eversion. Twenty-five patients were eligible for the study. Nineteen men and 6 women had a median age of 63 years (range, 20-84 years). All 25 patients had high-dose radiation therapy for their head and neck cancer. All but 1 patient had major cancer ablative surgery performed before radiation therapy. Thirteen of 25 patients also received chemotherapy. There was 100% viability of the skin grafts used for the repair of lower eyelid cicatricial ectropion. There were a few postoperative complications including the need for revision surgery to correct residual ectropion in the lower eyelid in 2 patients, and a third patient required a revision surgery due to upper eyelid retraction and lagophthalmos after harvest of skin graft from the upper eyelid. Improvement was noted in the subjective symptoms in 22 of 25 patients (88%), whereas 17 patients (68%) were noted to have improvement in their clinical findings on slit lamp examination. All 20 patients, for whom good quality photos were available, had improvement in the degree of cicatricial lower eyelid ectropion as measured by the amount of inferior scleral show and tarsal conjunctival eversion, although 11 patients had some residual ectropion. All 20 had either good or excellent results in the appearance of their skin grafts. Our findings suggest that full-thickness skin grafts are a nice option for correction of cicatricial lower eyelid ectropion in a previously radiated field; 100% of the grafts survived. The majority of patients had improvement of ocular surface damage and symptoms, with a decreased dependence on topical lubricants. All evaluable patients had improvement in the degree of cicatricial lower eyelid ectropion, although close to one-half of patients had some mild residual ectropion. The majority of patients had excellent appearance of the skin graft.

The Use of Fibrin Tissue Glue in the Repair of Cicatricial Ectropion of the Lower Eyelid

To evaluate the effectiveness of full-thickness skin graft adhesion using fibrin tissue glue (TISSEEL) in cicatricial ectropion repair of the lower eyelid. This study was a prospective case series. Nine eyes of 8 consecutive patients with cicatricial ectropion were included. All patients underwent a conjunctival approach lower eyelid retractor plication, lateral tarsal strip, and insertion of a full-thickness skin graft secured with TISSEEL. Symptoms of epiphora, eye and eyelid irritation, discharge, and graft size were recorded pre- and postoperatively. All of the patients were satisfied with their postoperative appearance, and the symptoms of eye and eyelid irritation, discharge, and visual disturbance were eliminated. Fifty-five percent of patients had complained of watering some or all of the time preoperatively, whereas only 33% admitted to occasional watering postoperatively. The average size of the graft reduced by 18% at 1 week, 39% at 1 month, and 40% at 3 months from the initial size. Fibrin tissue glue used to attach a full-thickness skin graft during cicatricial ectropion repair is an effective technique and may offer additional benefits over sutured graft fixation. Most of the reduction in graft size occurred in the first postoperative month, which indicates that the time window for modulation of the graft is in the first few weeks after surgery. The vertical graft length was affected to a greater extent than the horizontal length.

Complications of Cicatricial Ectropion Repair with Pre-Auricular Wolfe Graft.

An 85-year-old lady presented with a severe cicatricial ectropion several months after a fall. The abnormality was corrected with a procedure that involved the use of a retroauricular skin graft. This provided resolution of her ocular symptoms. Several months later, she had noted significant hair growth on the graft, but elected for this to be managed conservatively. Careful harvesting of the graft from the non-hairy area between the ear and the hairline is essential to prevent unwanted transplantation of terminal hairs. Surgical success is also dependent on the final aesthetic outcome.

Cicatricial ectropion: repair with myocutaneous flaps and canthopexy

To evaluate the effectiveness of myocutaneous upper eyelid flaps combined with canthopexy to treat cicatricial lower eyelid ectropion. A prospective non-comparative case series undertaken in a private practice setting. Consecutive patients with moderate lower eyelid cicatricial ectropion and upper eyelid dermatochalasis underwent transfer of a bipedicle or monopedicle flap from the upper eyelid combined with canthopexy. The main outcome measures included the occurrence of complications, eyelid position and cosmesis. Sixty-two consecutive cases of cicatricial ectropion repair using myocutaneous flaps and canthopexy. After a mean follow up of 20 months, 58 (93.5%) of the cases had the lower lid punctum facing posterosuperior into the tear lake, showed lid globe apposition and satisfactory eyelid position. There was mild recurrence of cicatricial ectropion in four patients (6.5%). There were no cases of graft failure or granuloma formation. The use of a myocutaneous flap from the upper eyelid combined with a canthopexy suspension suture for repair of cicatricial ectropion may offer good eyelid position and function. This technique has the advantage of avoiding full thickness blepharotomy and was associated with a low incidence of early recurrence.

Repair of cicatricial ectropion in an infant with harlequin ichthyosis using engineered human skin

PURPOSE: To report the use of an Apligraf (Organogenesis, Inc., Canton, Massachusetts, USA) human skin equivalent for repair of cicatricial ectropion in a patient with harlequin ichthyosis. DESIGN: Interventional case report. METHODS: A 6-week-old male child with harlequin ichthyosis and severe bilateral upper eyelid cicatricial ectropion underwent repair with Apligraf grafts. RESULTS: After the initial repair with Apligraf grafts, recurrent bilateral upper eyelid ectropion developed, requiring repeat Apligraf grafting at age 61 days. After the second graft, the eyelids remained well positioned until the child’s sudden death from respiratory failure at age 6 months. CONCLUSION: Apligraf human skin equivalent facilitated the repair of cicatricial ectropion in a child with harlequin ichthyosis.

Eyelid retractor surgery as an adjunct to cicatricial ectropion repair.

To evaluate the effectiveness of eyelid retractor repair in cicatricial ectropion of the lower eyelid. The study design was a prospective case series. One hundred and twenty eight eyelids were operated on in 100 consecutive patients with cicatricial ectropion. All patients underwent lower eyelid retractor repair via a conjunctival approach combined with skin replacement to the anterior lamella with or without a horizontal lid tightening procedure. When only medial ectropion was present, a medial-based transpositional skin flap was used to repair the anterior lamella (26 eyelids). The remaining eyelids with ectropion involving all or most of the eyelid underwent upper-to-lower eyelid lateral-based transpositional skin flap repair (92 eyelids), or full thickness free skin grafting (10 eyelids). Horizontal lid tightening was performed by lateral canthoplasty in 123 eyelids. Relief of cicatricial ectropion symptoms was reported in 90% of patients overall. A normal punctum position was achieved in 70% of eyelids, overall, and was highest (88%) with a medial-based transpositional skin flap. Eyelid retractor repair combined with skin replacement and horizontal lid shortening is an effective procedure for cicatricial ectropion.

Bipedicle Myocutaneous Flap Repair of Cicatricial Ectropion

We present a new approach to the bipedicle myocutaneous upper eyelid to lower eyelid flap in the repair of cicatricial ectropion in lower eyelid reconstruction, and in the release of tension caused by a previous cheek rotational flap. By incorporating the pedicles into the flap design, we prevent the persistent lymphedema and the raw tissue placed against exposed epidermis encountered in previous bipedicle myocutaneous flaps. Although there may be disadvantages associated with this procedure, we have not encountered any to date. Advantages of this procedure include the double source of blood supply and the superior cosmetic result as well as the avoidance of a second operative procedure. We recommend the use of the bipedicle myocutaneous flap in selected cases.