Medial Canthal Reconstruction Research Articles

Advanced adenoid cystic carcinoma of the conjunctiva: total upper eyelid and medial canthal region reconstruction with three local flaps plus auricular cartilage graft

Advanced adenoid cystic carcinoma of the conjunctiva: total upper eyelid and medial canthal region reconstruction with three local flaps plus auricular cartilage graft

Amniotic Membrane in Medial Canthal Reconstruction

To describe the use of amniotic membrane for reconstruction of large medial canthal defects. Four cases of medial canthus resection of cutaneous malignancies were reconstructed using amniotic membrane to cover exposed sclera and orbital fat, combined with other reconstructive techniques including titanium plating and myocutaneous flaps. Complete epithelialization of the scleral defect covered with amniotic membrane was seen within 6 weeks in all 4 patients. Amniotic membrane is useful for complex reconstructions of the medial canthus, and can be combined with other techniques such as myocutaneous flaps. This technique results in good functional and cosmetic results.

Medial canthal reconstruction with combined glabellar and orbicularis oculi myocutaneous advancement flaps

Medial canthal reconstruction following skin cancer excision presents a challenge to the plastic surgeon because of the complex anatomy and the difficulty in obtaining tissue of the appropriate colour and thickness. Reconstruction with local flaps adjacent to the defect is often the first-choice treatment option. The authors have performed reconstruction with combined glabellar and orbicularis oculi myocutaneous advancement flaps in 12 patients. A glabellar flap that can be divided into two parts was designed and elevated according to the defect in the medial canthal. The glabellar flap was transferred to the medial canthal defect after thinning. The residual area of medial canthal defect, which frequently involves the upper eyelid and inferior eyelid, was closed with an orbicularis oculi myocutaneous advancement flap. Reconstruction employing this procedure was performed on 12 patients with defects after resection of a medial canthal basal cell carcinoma. No recurrence was observed in any of the patients, and satisfactory results, including aesthetic results, were obtained for all patients. This technique can be readily used for relatively large medial canthal defects involving upper/inferior eyelid defects according to the size and shape of the defect. It is also aesthetically pleasing because of the inconspicuous postoperative suture line, which is consistent with the topographic curve.

Effectiveness of canalicular laceration repair using monocanalicular intubation with Monoka tubes

This study aimed to evaluate the clinical efficacy of canalicular laceration repair using monocanalicular intubation with Monoka tubes. A total of 36 single lacerated canaliculi were repaired using monocanalicular intubation with Monoka tubes, without mucosal anastomosis of the canaliculi, and were retrospectively reviewed. Demographic information, injury locations, associated ocular injuries, complications and outcomes were analysed. Mean patient age was 34 years (range 1-64 years). Tubes were removed at a mean of 4.2 months (range 3-6 months). There were 26 lower canalicular lacerations (72%) and 10 upper canalicular lacerations (28%). Overall, 34 of 36 cases (92%) showed improvement in symptoms and exhibited positivity on the dye disappearance test at 4-12 months after the procedure (mean 7.8 months). In total, 21 patients (58%) achieved complete success, 13 patients (36%) achieved partial success and two patients (6%) suffered surgical failure. Complications were seen in five cases and included two early tube protrusions, two punctal slits and one punctal granuloma. Monocanalicular intubation with Monoka tubes leads to successful outcomes without significant complications and offers an alternative to bicanalicular intubation in the treatment of monocanalicular lacerations.

The Use of the Superthinned Inferior Pedicled Glabellar Flap in Reconstruction of Small to Large Medial Canthal Defect

Medial canthal defects resulting from tumor resection are often too large to be closed directly because local tissue is in short supply. They can be repaired by using skin-muscle flaps or full-thickness skin graft to highlight a different technique, which may improve the cosmetic results achieved with this flap by reducing the tendency for the eyebrows to be drawn together. The superthinned inferior pedicled glabellar flap technique was used prospectively in 8 patients requiring medial canthal reconstruction. All patients were satisfied with the cosmetic and functional results. Photographs of all patients illustrate the preoperative and postoperative appearances of the eyebrows.This superthinned inferior pedicled glabellar flap technique is recommended to avoid drawing the eyebrows and bulky appearance in medial canthal region together when using the glabellar flap.

Medial Canthal Reconstruction with Glabellar Combined Rintala Flaps

In medial canthal reconstruction, the continuity of color and texture and the reproduction of natural external appearance are required, and reconstruction with a flap adjacent to the defect is frequently performed as the first choice. The authors have performed reconstruction with a glabellar flap combined with a Rintala flap in five patients. A glabellar flap, which is rectangular according to the unit principle, was elevated, and after thinning and trimming to the defect shape, was transferred to the medial canthal defect. The donor site of the glabellar flap was closed with a Rintala flap. Reconstruction by means of this procedure was performed in five patients with defects after resection of medial canthal basal cell carcinoma. In one patient with extension of the defect to the upper and lower eyelids, the tip of the glabellar flap was divided into two portions and transferred to the defective site. No recurrence was observed in any patient, and satisfactory results including aesthetic results were obtained in all patients. This technique can be performed readily and is applicable to the reconstruction of relatively large defects and is also aesthetically excellent because of a postoperative suture line that is consistent with the topographic curve. This technique may be useful for medial canthal reconstruction.

Medial Canthal Reconstruction by a Modified Glabellar Flap

Aims: To present a modified technique for the preparation of glabellar skin flaps to reconstruct medial canthal defects. Methods: Ten consecutively treated patients were included who had skin defects after resection of skin tumours like basal cell carcinomas in the medial canthal area of a medium vertical diameter of 2.5 cm. The defects were closed by preparation of a modified glabellar flap. The pedicle of the flap was guided through a skin tunnel prepared diagonally at the root of the nose. The pedicle was resected 4 weeks after the initial surgery. Results: In all 10 cases, the procedure was adequate for reconstruction of the defect. There were no flap necroses and the cosmetic results were favourable in all cases. The resection of the pedicle could be performed easily in an out-patient procedure 4 weeks after the operation. Conclusion: Glabellar flaps are established procedures to reconstruct medium to large defects of the medial canthus. Skin distortion in the area of the flap pedicle leading to a skin bulge and visible scars at the root of the nose and medial transposition of the eye brows can be reduced by a modification of the surgical technique preparing a skin tunnel for the flap pedicle. In our hands, the cosmetic results are better with the modified technique in comparison to the original procedure.

Use of the Pericranial Flap in Medial Canthal Reconstruction: Another Application for This Versatile Flap

To describe the use and outcomes of a versatile surgical technique in the reconstruction of deep soft tissue and bony defects of the medial canthus. A retrospective review of consecutive cases requiring reconstruction of medial canthal defects involving loss of periosteum or bone by a median forehead pericranial flap and full-thickness skin grafting in a tertiary referral hospital setting. Two techniques were used: an open technique, using a midline forehead incision; and an endoscopic technique, using 2 incisions behind the hairline. Twenty-one cases were identified: 19 open and 2 endoscopic. The average length of follow-up was 13 months (range, 6-50 months). Ten cases required additional oculoplastic procedures including local periosteal flaps and mucous membrane grafts. Two cases (10%) had complete flap failure; one of these was caused by infection. Five (24%) had partial (< 50%) skin graft necrosis. Two cases (10%) have required further surgery. Our experience shows the pericranial flap to be versatile, robust, and easy to manipulate, offering advantages over alternative techniques when used for the repair of deep medial canthal defects. It is a valuable reconstructive technique that can yield good cosmetic and functional results.

Upper eyelid rotation flap for reconstruction of medial canthal defects

M edial canthal defects resulting from cancer resection after Mohs micrographic surgery present challenging reconstruction dilemmas. In fact, medial canthal reconstruction has been controversial because of the time-honored method of second-intention healing in wound management of this area. Yet, small flaps and grafts for repair of cutaneous medial canthal defects may result in a quicker healing process with excellent cosmetic results. The main difficulties of reconstruction of the medial canthal region are the lack of local availability of similar thin eyelid skin, and the concavity of the defect to be repaired. The area of the medial canthus includes the free tissue margins of the upper and lower eyelids, the bony attachments of the medial canthal tendon, the lacrimal puncta, and arteriovenous and neural bundles that supply and innervate the region. The literature describes a multitude of surgically complex and intricate reconstruction methods including eyelid myocutaneous transposition flaps, glabellar flaps, cheek flaps, V-Y advancement flaps, and skin grafts for repair of defects of the medial canthus. Although these reconstructive options represent tested and widely used choices for medial canthal restoration, they are limited in that these techniques often provide a less than ideal color or texture match, provide tissue that is either too thick or too thin, or place incisions that cross aesthetic units and boundaries. We describe a novel flap that is conceptually simple to design and execute for the repair of medial

A simple modification of the glabellar flap in medial canthal reconstruction.

To highlight a simple modification of the traditional glabellar flap, which may improve the cosmetic results achieved with this flap by reducing the tendency for the eyebrows to be drawn together. The modified surgical technique is described and used prospectively in 10 patients requiring medial canthal reconstruction with a glabellar flap. All patients were satisfied with the cosmetic and functional results. Photographs of one patient illustrate the preoperative and postoperative appearance of the eyebrows. This simple modification is recommended to avoid drawing the eyebrows together when using the glabellar flap.

Medial Canthal Reconstruction Using a Medially Based Upper Eyelid Myocutaneous Flap

Periorbital reconstruction following skin cancer ablation represents a challenging problem. A thorough understanding of the complex periorbital anatomy is necessary to preserve lid function and protect the ocular surface. The medial canthal region represents the most difficult periorbital zone to reconstruct. This area has a complex anatomy involving both the medial canthus itself and the lacrimal apparatus. The authors present their experience with a versatile technique for reconstruction of the medial canthal periorbital region, namely, a medially based upper eyelid myocutaneous flap. In the 10 patients in whom this procedure was used, there was one partial and no complete flap losses. The authors believe that the medially based upper lid myocutaneous flap offers an excellent solution to the difficult problem of medial canthal periorbital reconstruction. (Plast. Reconstr. Surg. 110: 1636, 2002.)

A simple method for medial canthal reconstruction

Abstract.A simple method for medical canthal wiring reconstruction with the help of a homolaterally fixed osteosynthesis plate and a metal wire is presented. This avoids transnasal wiring and gives superior control when correcting the position of the lacerated Omedial canthus.

Multiple aesthetic unit flaps for medial canthal reconstruction.

The medial canthal region includes several individual aesthetic units that differ in skin quality and thickness, contour, and associated landmarks. Basal cell carcinomas commonly involve the medial canthal region and extend without respecting the boundaries between units. Reconstruction of tumor-free defects is often complicated by web formation across the medial canthal concavity. To avoid this complication, we evaluate each defect according to the anatomic units involved and develop individual flaps from each component area, anchoring each flap to the medial canthal tendon or associated deep fibrous tissue. This system has been used in 58 cases with excellent results. It allows flexibility for reconstructing the many diverse defects that oculoplastic surgeons encounter and helps to minimize postoperative deformity.

Bilobed flap repair in medial canthal reconstruction

Bilobed flap repair in medial canthal reconstruction

Trans-Nasal Flap for Medial Canthal Reconstruction

The trans-nasal flap is an effective method for repairing medial canthal defects following Mohs' surgery. This procedure transposes redundant skin from the nasal bridge into the defect. The construction of the flap, which minimizes the risk of medial canthal webbing, yielded excellent cosmetic results in 22 patients.

Reconstruction of the medial canthus: full-thickness skin graft or local flap?

Forty-nine patients with skin tumors in the medial canthal area were operated on from 1986 to 1992. Forty-one of 43 surviving patients (95%) could be re-examined with an average follow-up of two years. In 20 patients, a full-thickness skin graft was used for the immediate reconstruction, in 21 patients a local flap, and in a further 8 patients, both methods were used in combination for the surgical repair. The histology of the lesions was mainly basal cell carcinoma; these may show aggressive extension in the medial canthal region. With the high accuracy intraoperative frozen section, immediate reconstructive surgery was performed after surgical excision. The results of the medial canthal reconstruction, using local flaps or full-thickness skin grafts, were compared in terms of the final functional and cosmetic result. The size and depth of the defect after eradication of the tumor was taken into consideration.

Use of vertical and horizontal traction sutures in eyelid surgery

Patients with lid surgery may benefit from traction sutures. However no detailed descriptions of the techniques exists. We describe our techniques and experiences in patients with cicatricial ectropion and large lid defects. In 33 patients with severe cicatricial ectropion, the wound was extended with transtarsal traction sutures before skin grafts or sliding flaps were sutured in place. Horizontal traction sutures allowed wound closure in 7 patients with tumors of the medial canthal area or large traumatic lid defects. In all patients monofil 4-0 polypropylene suture material was used. Vertical transtarsal traction sutures and horizontal traction sutures did not cause any irritations of the lids or wound edges. Postoperative overcorrection of the lower lid margin was achieved in all ectropion patients. However, five patients required additional surgery. Three patients were operated for bilateral cicatricial ectropion simultaneously. Postoperative shrinkage of the free skin-graft was more accelerated on the side where the transtarsal traction sutures were first removed. Horizontal traction sutures allowed wound closure in all seven patients who had undergone medial canthal reconstruction and traumatic lid repair. Traction sutures with monofil 4-0 polypropylene material can fixate the lid margins and wound edges in the preoperatively desired position. There is evidence that the traction sutures can influence postoperative wound contraction. Our technique of transtarsal traction sutures has several advantages as compared with previously described techniques.

Eyelid tumors, trauma, and reconstruction

During the past year, refinements in the treatment of many lid tumors have been proposed, including amyloidosis, Kaposi's sarcoma, sebaceous carcinoma, basal cell carcinoma, squamous cell carcinoma, and melanoma. There have also been innovative reports on eyelid reconstruction using hard-palate mucosal grafts, medial canthal reconstruction, lateral skin-muscle advancement flaps, and eyelid avulsions.

The midline forehead island flap.

The midline forehead island flap exemplifies pedicled island flaps based on random circulation. The use of this flap for medial canthal reconstruction is set forth by photographs, diagrams, and appropriate commentary.