Reconstruction Of Medial Canthal Defects Research Articles

Biplanar-pivoted V-Y Flap for Reconstruction of Medial Canthal Defects.

To determine the safety and effectiveness of a biplanar-pivoted V-Y flap design in reconstructing medial canthal defects of all sizes. Retrospective review of patients who underwent repair of medial canthal region defects with the biplanar-pivoted V-Y flap from January 2016 to May 2021. Variables collected included age, gender, surgical indication, defect sizes and location, flap(s) and/or graft(s) used, and follow-up time. Outcome measures included complications, patient satisfaction with cosmesis, ability to close the defect with minimal wound tension, and additional surgeries. Eighteen cases of medial canthal, nasal sidewall, and nasojugal fold area reconstruction were performed using a biplanar-pivoted V-Y flap in 18 patients. The cohort included 7 males and 11 females with a mean age of 72.4 years (range, 52-92 years) and mean follow-up time of 4.4 months (range, 1-14 months). Mean defect size was 2.0 × 1.4 cm (range, 0.5-5.5 cm). Eight patients received concomitant full-thickness skin grafts, five patients underwent simultaneous rotational flap repair, one patient underwent simultaneous nasoglabellar myocutaneous flap repair, and one patient received a simultaneous traditional, nonbiplanar V-Y plasty of the upper eyelid. All defects were closed with no wound tension. No cases of infection, hemorrhage, or wound dehiscence occurred during follow-up. Complications included mild ectropion (2 patients) and mild tip necrosis (1 patient). No patients elected for reoperation. No trapdoor deformity was observed. No patients underwent reoperation for local tumor recurrence. The extended mobility of the biplanar-pivoted V-Y flap provides excellent closure of defects involving the medial canthal region with minimal surgical complications.

A Modified Rhomboid Flap for Medial Canthal Reconstruction.

Background:The reconstruction of medial canthal defects is often challenging in achieving continuity of color and texture, obtaining adequate tissue for large defects, and the reproduction of natural external appearance with inconspicuous scars. We describe a technique for reconstruction of the medial canthal area, using a modified rhomboid flap.Methods:The technique is based on the use of a modified rhomboid flap for medial canthal defects—superiorly based on the root of the nose for defects mostly above the medial canthal tendon, inferiorly based on the cheek for defects mostly below the medial canthal tendon, and in cases of large defects, using a combination of the two flaps. We present a case series of five patients successfully reconstructed with the mentioned technique after resection of medial canthal basal cell carcinoma.Results:Of the five patients with a mean age of 76.2 years (range 62–84 years), reconstruction was performed in three patients with a superiorly based rhomboid flap, in one patient with an inferiorly based rhomboid flap, and in another patient with a large defect using a combination of the two flaps. Mean follow-up was 374.4 days (range 30–1247 days). All patients achieved a complete primary closure with no further surgery and satisfactory cosmetic and functional results.Conclusion:The modified rhomboid flap is a simple and reliable technique for all defects of the medial canthal area.

Reconstruction of Medial Canthal Defects by Local/Loco-Regional Flaps.

To describe a series of medial canthal defect reconstruction by local/loco-regional flaps following excision of basal cell carcinoma. A series of 35 medial canthal defects following excision of basal cell carcinoma was reconstructed by local/loco-regional flaps. For smaller defects, glabellar lateral advancement flap or Limberg's flap from the nasolabial area were used to resurface the defects. For larger defects extending to the upper and lower eyelid or to the nose, a combination of flaps, that is, forehead and cheek rotation flaps or glabellar and cheek rotation flaps were used. In all the cases, the aesthetic and functional results were highly satisfactory except in one, where punctum and lower canaliculi were also excised with the tumor for clearance. This patient complained of watering from the affected eye. Two patients had developed webbing after the operation. It was corrected by Z plasty after 6 months. Medial canthal defects are best managed by local/ loco-regional flaps. For smaller defects in the upper part, the glabellar flap is the choice of the flap and in the lower part, flaps from the nasolabial region give the best result. For larger defects not amenable to single flap, a combination of flaps (glabellar/forehead flap and cheek rotation flap) can close the defects with the good aesthetic and functional results.

Effect of Eyelid Involvement in the Reconstruction of Medial Canthal Defects Following Tumor Excision: Retraction.

Effect of Eyelid Involvement in the Reconstruction of Medial Canthal Defects Following Tumor Excision: Retraction.

Effect of Eyelid Involvement in the Reconstruction of Medial Canthal Defects

The purpose of this study was to present surgical techniques for the reconstruction of medial canthal defects with and without the involvement of the eyelid. This study included 31 patients who underwent medial canthal reconstruction after tumor excision during a 6-year period. Data regarding patient demographics, defect size, tumor pathology, surgery techniques, functional and cosmetic outcomes, and complications were recorded. The reconstructive methods used in the study were divided into groups as per the site of the defect (medial canthal, medial canthal with upper eyelid, medial canthal with lower eyelid, and medial canthal with both eyelids). The most common histopathological diagnosis of the lesions was basal cell carcinoma (74.2%). Postoperative complications (6.4%) included flap necrosis in one patient and lid margin notching in another. Among patients who underwent reconstruction, 8 (25.8%) had only medial canthal defect, 6 (19.3%) had medial canthal defect extending to the upper eyelid, 7 (22.6%) had medial canthal defect extending to the lower eyelid, and 10 (32.3%) had medial canthal defect extending to both the eyelids. The functional outcome was regarded as normal in 30 (96.8%) patients and limited in 1 (3.2%) patient. Cosmetic outcomes were satisfactory in all the patients. The use of alternative reconstructive approaches for different subunits of the medial canthus is an efficient method to achieve superior functional and cosmetic outcomes.

Effect of Eyelid Involvement in the Reconstruction of Medial Canthal Defects Following Tumor Excision

The aim of this study is to present surgical techniques for medial canthal defects with and without involvement of eyelid. This study included 31 patients who had undergone medial canthal reconstruction after tumor excision during a 6-year interval. Data about patient demographics, defect size, tumor pathology, surgery techniques, functional and cosmetic outcomes, and complications were recorded. The reconstructive methods used in the study were divided into groups according to the site of the defect (medial canthal, medial canthal with upper eyelid, medial canthal with lower eyelid, and medial canthal with both eyelids). Most common histopathologic diagnosis of the lesions was basal cell carcinoma (74.2%). Postoperative complications (6.4%) included flap necrosis in 1 patient and lid margin notching in 1 patient. Among patients who underwent reconstruction, 8 (25.8%) had only medial canthal defect, 6 (19.3%) had medial canthal defect extending to upper eyelid, 7 (22.6%) had medial canthal defect extending to lower eyelid, and 10 (32.3%) had medial canthal defect extending to both eyelids. The functional outcome was regarded as normal in 30 (96.8%) patients and limited in 1 (3.2%) patient. All of the patients considered cosmetic result as satisfactory. Alternative reconstructive approaches for different subunits of the medial canthus are an efficient way to provide superior functional and cosmetic outcomes.

A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps

Background Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions. Objective To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region. Methods Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma. Results All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed. Conclusion This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.

A useful flap combination in wide and complex defect reconstruction of the medial canthal region: Glabellar rotation and nasolabial V-Y advancement flaps.

Reconstruction of medial canthal defects after tumour excision is difficult owing to the thin skin of the region and the concavity of the anatomical landmarks, which enclose complex structures such as the medial canthal ligament and the lacrimal system. Local reconstruction methods for this region include secondary healing, full-thickness skin grafts, and skin flaps from the frontal, transnasal, glabellar and upper eyelid regions. To demonstrate a useful combination of two local flaps in wide defects of the medial canthal region. Between 1998 and 2012, a combination of glabellar rotation and nasolabial V-Y advancement flaps were used in 11 patients with wide complex defects after excision, including periosteum, of invasive basal cell carcinoma. All patients were tumour free and underwent functional and aesthetic reconstruction of the medial canthal region. There were no major complications, and no relapses were observed. This technique achieves good match in colour and texture, and has satisfactory results both aesthetically and functionally. In addition, donor area morbidity is minimal and surgical technique is simple.

The figure-of-eight radix nasi flap for medial canthal defects

Basal cell carcinomas commonly involve the medial canthal region and reconstruction of medial canthal defects is a challenging problem in reconstructive surgery. A new axial pattern flap raised from radix nasi region has been successfully used for the medial canthal defects in eight patients in figure-of-eight manner. One of the ellipses of the figure of eight is the defect, the other is the radix nasi flap. The radix nasi flap with a dimension up to 25 mm is transposed to the defect based either on ipsilateral anastomosis of the dorsal nasal artery with angular artery (AA) or with the connection of its source artery (i.e. ophthalmic artery) if the AA is damaged. All flaps survived and no tumour recurrence was observed. The donor sites were closed primarily and hidden at the radix nasi crease in all cases. The radix nasi flap in figure-of-eight fashion is good alternative for defects of the medial canthal area in terms of attaining a suitable colour and texture and minimal surgical scars.

A New Glabellar Flap Modification for the Reconstruction of Medial Canthal and Nasal Dorsal Defects

In considering periorbital reconstructive options, the goals of reconstruction are to obtain functional and esthetic results. At the medial canthus, reconstruction should maintain the normal concavity of the canthus without distortion of the surrounding tissues and should maintain normal eyebrow contour and symmetry. The authors represent their flap in flap technique that provides normal concavity of the canthus and does not cause any complex and undesirable scars. A new modification of conventional glabellar flap which was named "flap in flap technique" was raised to cover medial canthal defect. We designed an inverted V-shaped advancement flap (123Delta-A flap) that contains both B (145Delta flap) and C (2345) flaps. The B flap is designed in the glabellar region, which is at medial side of the defect and is transposed to defect, and the C flap is planned in V-Y fashion to release tension over the B flap. To date, we have used this technique successfully in 5 patients (4 women and 1 man), requiring a glabellar flap to reconstruct the medial canthus and proximal nasal dorsum. All defects were secondary to excision of basal cell carcinoma. All were satisfied with the cosmetic and functional results. Our glabellar flap in flap technique for the reconstruction of medial canthal defects has several advantages such as maintaining concavity of the canthus without distortion of the surrounding tissues and providing normal eyebrow contour and symmetry.

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.

Infraglabellar Transnasal Bilobed Flap in the Reconstruction of Medial Canthal Defects

We investigated the effectiveness of reconstruction using an infraglabellar bilobed flap of transnasal skin and subcutaneous tissue for patients with medial canthal defects. Our noncomparative interventional case series involved 11 consecutive patients with medial canthal defects following Mohs micrographic excision of basal cell carcinoma. The medial canthal area was divided into 3 zones: zone 1, just above the medial canthal tendon; zone 2, centered on the medial canthal tendon; and zone 3, just below the medial canthal tendon. Primary closure was achieved easily with a good cosmetic result for all 3 zones. There were no complications or further procedures required. The outcome measures documented clinically and photographically included complete closure of the defect, cosmetic appearance, complications, and further surgery.

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

Reconstruction of the medial canthal eyelid. Methods, problems and outcome

Histologically controlled excision of medial canthal eyelid tumors often creates large skin defects, which may be closed by various reconstruction techniques. To obtain information about indications for surgery, complications, and esthetic and functional results we analyzed 39 of our patients who underwent surgery in this area between August of 1995 and January 1998. Four small defects were closed primarily. A free full-thickness skin graft was used in 15 patients with a medium-sized defect, and 18 patients with large defects were handled by a local rotation or transposition flap. Granulation was left to occur spontaneously in two patients in poor general health. No tumor recurrences were seen. The functional and esthetic results were good. After 3 months free transplants and rotational flaps had healed in well. Increased scarring with mild medial ectropion was seen in five patients with rotation flaps. Patients who were left to spontaneous granulation required a more intensive and longer local treatment. For the reconstruction of medial canthal defects after tumor excision, free skin transplants were used for small to medium, and rotation flaps for large defects. These are successful procedures with good functional and esthetic results. Spontaneous granulation is an acceptable therapeutic alternative for patients in poor general health.