Reconstruction Of Lower Eyelid Defects Research Articles

Customized Reconstruction of Lower Eyelid Defects.

A lower eyelid defect is a loss of skin, muscle, and underlying structures that can occur due to trauma, malignant or benign tumors, burns, or other causes. The conventional surgical treatment of lower lid defects has several limitations, including visible scarring, narrowing of the eye, and ectropion. Here, we combined the use of a customized mid-face lift with a free mucochondral graft to overcome the disadvantages of existing methods. Forty patients underwent reconstructive surgery using a customized mid-face lift with or without a free mucochondral graft for a lower lid defect between April 2013 and October 2020. Patients were discharged shortly after surgery and were expected to visit the outpatient clinic periodically for 12 months. The causes of lower eyelid defects were malignancy, trauma, foreign body granuloma, and other causes. Four patients reported complications, including 2 cases of chemosis, 1 case of a hematoma, and 1 case of corneal abrasion, who reportedly performed well after 2 weeks of conservative therapy. No patient required revision during the average follow-up period. Customized reconstruction demonstrated a better aesthetic reconstruction of the lower eyelid. This method represents a good option for reconstructing lower lid defects.

The Utility of the Paramedian Forehead Flap in Lower Eyelid Reconstruction.

Malignant cutaneous eyelid tumors account for approximately 10% of all cutaneous cancers. Like other cancerous skin lesions, treatment commonly involves excision with wide margins, requiring tissue reconstruction. The use of the paramedian forehead flap (PMFF) has been described for reconstruction of the medial and upper eyelid, but literature is lacking for its use in lower eyelid anterior lamella reconstruction. We present a case series of patients who underwent reconstruction of lower eyelid defects using the PMFF. We present 2 patients who underwent reconstruction of lower eyelid defects using the PMFF surgical technique. The patients had previous history of lower lid repair with other reconstructive methods because of cancerous eyelid lesions. In addition, both received adjuvant radiation therapy, which led to development of ectropion. Postoperative signs, symptoms, and photographs were collected to monitor outcomes. Reconstructions were performed by the collaborative efforts of a facial plastic reconstructive surgeon and oculoplastic surgeon using a staged PMFF approach. Postoperatively, both patients had significant improvement in ophthalmologic symptoms, particularly ectropion and lagophthalmos. At their most recent follow-up visit, they were satisfied with their functional and aesthetic outcomes. The PMFF may be safely used to reconstruct defects of the lower eyelid anterior lamella. In this study, the PMFF has proven to be an excellent option for patients with complications after previous lower eyelid reconstructions or history of radiation therapy. Overall, the PMFF should be considered as part of the surgeon's reconstructive ladder when addressing lower eyelid defects.

Free Tarsal Graft and Free Skin Graft for Lower Eyelid Reconstruction.

To determine whether reconstruction of lower eyelid defects involving the eyelid margin with a free tarsal graft and an overlying free skin graft, without retention or provision of any vascular support, would yield acceptable functional and cosmetic results. We present here a clinical series of 4 patients treated between April 2019 and September 2019 who underwent reconstruction of large postcarcinoma excision, eyelid-margin-inclusive eyelid defects. Surgery was performed by the same surgeon (J.G.B.) at the Westchester Medical Center, Department of Ophthalmology and Dobbs Ferry Hospital in New York. Without retaining a conjunctival pedicle (modified Hughes procedure), and without a myocutaneous or other vascularized flap, the lower eyelids were reconstructed with a free tarsal graft and a separate overlying free skin graft. The primary outcomes measured were eyelid apposition to the globe, margin reflex distance 2 at least 6 months postoperatively, ocular surface integrity, and patient comfort and patient satisfaction with the procedure. The patients included in the clinical series ranged in age from 73 to 82, 3 were men and 1 women. Each had recent Moh's excision of carcinoma (3 basal; 1 squamous) resulting in large tissue defects of the lower eyelids. All carcinomas were T1N0M0. The mean postoperative margin reflex distance 2 of the reconstructed eyelids was 5.5 mm, range 5-7.5 mm. Two of the 4 patients underwent a secondary revision within 2-3 weeks following initial reconstruction for lateral ectropion or dehiscence. All eyelids were well-opposed to the globes after revision (except for the nasal eyelid in patient number 2 who had a preexisting ectropion from prior carcinoma excision in the same eyelid). Functional and esthetic results were on par with those of the modified Hughes procedure. All 4 patients were pleased that they had chosen to undergo the procedure being discussed. In this clinical series of 4 patients, reconstruction of lower eyelid defects with a free tarsal graft and overlying free skin graft resulted in an acceptable functional and esthetic lower eyelid suggesting that retention of or provision of vascular support in either the anterior or posterior lamella may not be necessary.

Lower Eyelid Reconstruction: A New Classification Incorporating the Vertical Dimension.

Lower eyelid defects are traditionally classified based on depth and 25 percent increments in defect width. The authors propose a new classification system that includes the vertical defect component to predict functional and aesthetic outcomes. A retrospective review of patients who underwent lower lid reconstruction performed by a single surgeon was performed. Defects were classified into four categories based on the vertical component: (1) pretarsal; (2) preseptal; (3) eyelid-cheek junction; and (4) complex pretarsal/preseptal. Preoperative and postoperative central and lateral marginal reflex distance-2 values were obtained. Aesthetic outcomes were evaluated by three blinded reviewers. Outcomes were compared using one-way analysis of variance and analysis of covariance with Bonferroni corrected post hoc comparisons to control for defect area and width. Thirty-four patients underwent reconstruction of lower eyelid defects. There were 12 pretarsal defects (type I), nine preseptal defects (type II), nine eyelid-cheek defects (type III), and four complex pretarsal/preseptal defects (type IV). Postoperative retraction was highest in the complex pretarsal/preseptal group at 75 percent, with a significantly greater change from preoperative to postoperative central and lateral marginal reflex distance-2 compared with the other groups (p < 0.01) and worse postoperative mean aesthetic scores (p < 0.001). Type IV patients had significantly more revision operations (mean, 5.5) compared with the other groups (p < 0.001). The vertical dimension of lower eyelid defects is an important variable. A new classification system is proposed that supplements width-based methods for improved surgical planning and prediction of postoperative outcomes in lower eyelid reconstruction. Therapeutic, IV.

Use of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects

Full-thickness skin grafts (FTSGs) and flaps from the upper eyelid or cheek can be used for reconstruction of lower eyelid defects, including the anterior lamella. However, the upper eyelid has a limited and insufficient amount of skin, whereas cheek flaps have a restricted arch of rotation. Here we report the procedure and outcomes of a perforator/subcutaneous pedicled propeller flap for reconstruction of lower eyelid defects including the anterior lamella. A retrospective study of 12 patients who underwent treatment for eyelid anterior lamella defects with perforator/subcutaneous pedicled propeller flaps was conducted between March 2015 and June 2017. The propeller flap was planned to rotate around the perforator (as the pivot point), which was detected with a hand-held Doppler in the vicinity of the defect. The flaps were perforator pedicled for 10 patients and subcutaneous pedicled for the other two patients. The flap was rotated around the pedicle and placed on each patient's defect without tension. No vascular compromise occurred with any of the flaps. The most important complications were post-operative oedema and ecchymosis. Inferior eyelid defects including the anterior lamella could be reconstructed by using propeller flaps from the adjacent tissue. The main advantages of this flap included easy access to the defect, no impairment in eyelid function and very good aesthetic results.

Le lambeau d’avancement horizontal en V-Y dans les reconstructions des pertes de substances non transfixiantes de la paupière inférieure chez le sujet jeune

The reconstruction of lower eyelid defects is a complex issue because of the thinness of eyelid tissues and the need for protection of the globe. The surgery must address two requirements: a functional goal, avoiding eyelid malposition, and a cosmetic goal, limiting aesthetic compromises. In young patients, direct closure is rarely possible if the defect is superior to 1cm. The horizontal V-Y advancement flap is a simple and reliable method but is hardly ever reported. The purpose of this study is to review the surgical technique and report our experience with this flap in the reconstruction of younger patients. Nine patients, 5 men and 4 women, with a mean age of 54 years, underwent a lower eyelid reconstruction by horizontal V-Y advancement flap between 2011 and 2014. In every case, the initial pathology was a basal cell carcinoma and the surgical margins were uninvolved. The mean diameter of the surgical defect was 1.9 centimeters and the average procedure duration was 40 minutes. All patients were managed as outpatients. Functional and aesthetic results were judged satisfactory or very satisfactory by all the patients and their surgeon. No flap necrosis and no ectropion or scleral show were reported. In one patient, lower lid edema lasted until the third postoperative month. The horizontal V-Y advancement flap enables to repair lower eyelid defects using nearby skin of similar characteristics. Aesthetic results are very satisfactory, and scars, concealed in the eyelid creases, are nearly invisible in the long term. The lack of tension on the eyelid margin limits the risk of eyelid position. This simple and reliable one-step procedure, possible under local anesthesia, is appropriate for young, active patients, limiting the cosmetic sequelae and social ramifications.

MÉTODOS RECONSTRUTIVOS DA PÁLPEBRA INFERIOR – APLICAÇÃO NA PRÁTICA DERMATOLÓGICA

Introdução: A ressecção de neoplasias cutâneas é a principal causa de defeitos palpebrais. Os princípios de reconstrução da pálpebra encontram-se bem definidos. No entanto, permanece um desafio conseguir um bom resultado funcional e estético. Material e Métodos: Conhecer as diversas técnicas cirúrgicas e os conceitos anatómicos é fundamental na abordagem de lesões palpebrais. Anatomicamente a pálpebra pode ser dividida em duas lamelas: a lamela anterior (pele e músculo orbicular) e a lamela posterior (tarso e conjuntiva).Resultados: Para efeitos reconstrutivos, os defeitos da pálpebra inferior podem ser divididos em dois principais grupos: (1) defeitos de espessura parcial, com a margem palpebral intacta e (2) defeitos de espessura total envolvendo a margem palpebral. As técnicas cirúrgicas de reconstrução da lamela anterior incluem retalhos miocutâneos de rotação ou de deslizamento e enxertos cutâneos. Para reconstruir a lamela posterior são necessários enxertos compostos (condrocutâneos ou condromucosos). Nos defeitos de espessura total ambas as lamelas têm de ser reparadas, para restaurar a função. Nos algoritmos de reconstrução, os defeitos palpebrais de espessura total são classificados em: pequenos (até 30% do tamanho horizontal da margem palpebral), médios (30-50%) e grandes (acima de 50%). Um pequeno defeito pode ser encerrado com sutura directa. Se necessário mobiliza-se a margem palpebral lateral 3 a 5 mm (cantólise lateral). Num defeito de tamanho médio pode ser aplicado um retalho. Para os defeitos de grandes dimensões, o cirurgião deve reconstruir a lamela posterior e planear a reconstrução da lamela anterior com uma combinação das técnicas anteriores. Os autores reviram a metodologia de reconstrução de defeitos da pálpebra inferior e exemplificam com casos da sua prática clínica. Conclusões: Existem inúmeras abordagens possíveis para restaurar a anatomia palpebral. O método reconstrutivo de eleição é individualizado caso a caso, com particular atenção à localização e dimensões do defeito.

Reconstruction of Lower Eyelid Defects Using a Cross Upper Eyelid Flap Composited with Ear Cartilage

BACKGROUND Basal cell carcinomas (BCC) most frequently involve the lower eyelid and are treated with total excision. Various techniques have been proposed for reconstruction of the excised eyelid. OBJECTIVE Because most flaps used in such techniques are bulky, thinner, and aesthetically more favorable, flaps have been sought recently. METHODS Defects of the lower lid have been closed with a combination of cross-flaps and choncal cartilage prepared from the upper eyelid. RESULTS Eleven lower lids from 10 patients operated for BCC were reconstructed. All flaps survived. The duration of follow-up was 10 months, and no complications such as relapse, ectropion, or lagophthalmus occurred. CONCLUSIONS The upper eyelid flap was found to be an appropriate cover for both the skin and the conjunctiva due to its hairless and smooth structure. The outcome in patients followed up for a mean of 10 months was successful, cosmetically and functionally.

Reconstruction of Lower Eyelid Defects Using a Cross Upper Eyelid Flap Composited with Ear Cartilage

Basal cell carcinomas (BCC) most frequently involve the lower eyelid and are treated with total excision. Various techniques have been proposed for reconstruction of the excised eyelid. Because most flaps used in such techniques are bulky, thinner, and aesthetically more favorable, flaps have been sought recently. Defects of the lower lid have been closed with a combination of cross-flaps and choncal cartilage prepared from the upper eyelid. Eleven lower lids from 10 patients operated for BCC were reconstructed. All flaps survived. The duration of follow-up was 10 months, and no complications such as relapse, ectropion, or lagophthalmus occurred. The upper eyelid flap was found to be an appropriate cover for both the skin and the conjunctiva due to its hairless and smooth structure. The outcome in patients followed up for a mean of 10 months was successful, cosmetically and functionally.

Reconstruction of the Lower Eyelid by Third Eyelid Lateral Advancement and Local Transposition Cutaneous Flap After “En Bloc” Resection of Squamous Cell Carcinoma in 5 Cats

To describe a novel technique for blepharoplasty to cover a tissue defect involving >/=50% of the lower eyelid. Prospective clinical study. Five cats with lower eyelid squamous cell carcinoma (SCC). En bloc resection of SCC by removing >/=50% of the lower lid with either the medial or lateral canthus was performed without other adjunctive treatment for SCC. The lid defect was reconstructed with a transposition skin flap derived from the frontal (medial defect) or temporal (lateral defect) region. The third eyelid was advanced laterally without dissection from its insertion; its outer conjunctival layer was removed, and the skin flap was sutured with single interrupted sutures dorsally over the nictitating membrane, ventrally to the cutaneous edge of the surgical wound and medially or laterally (depending on the canthus removed) to the skin of the remaining lower lid. Satisfactory cosmetic and functional results were achieved and the Schirmer tear tests were normal. In 2 cats, the skin flap needed monthly hair trimming to avoid corneal lesions. After en bloc resection of SCC involving >/=50% of the lower eyelid, reconstruction can be achieved by relocation of the third eyelid and use of a cutaneous transposition flap sutured to the scarified external surface of the third eyelid. Eyelid apposition and lacrimal function were preserved. Blepharoplasty using a cutaneous transposition flap sutured to the scarified surface of a relocated third eyelid should be considered for reconstruction of lower eyelid defects with >/=50% tissue loss of the lid margin.