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Ma T, Xu L, Chen Y, Zhang J, Han X, Si Y, Wang S, Jiang L. Use of the Acellular Dermal Matrix (ADM) to Reconstruct Full-thickness Eyelid Defects. J Craniofac Surg 2023; 34:e733-e736. [PMID: 37428985 DOI: 10.1097/scs.0000000000009499] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2022] [Accepted: 05/16/2023] [Indexed: 07/12/2023] Open
Abstract
This study aimed to introduce the use of an acellular dermal matrix (ADM) as a posterior lamellar substitution for full-thickness eyelid reconstruction after malignant tumor excision. After resection of the malignant eyelid tumors, anterior lamellar defects were repaired using direct sutures and pedicled flaps in 20 patients (15 men and 5 women). ADM was used to replace the tarsal plate and the conjunctiva. All patients were followed up for 6 months or more to assess the functional and esthetic outcomes of the procedure. The flaps survived in all but 2 cases, wherein they necrosed due to insufficient blood supply. The functionality and esthetic outcomes were excellent in 10 and 9 patients, respectively. There were no changes in visual acuity or corneal epithelial damage after the surgery. The eyeball movement was good. Corneal irritation no longer appeared, and patient comfort was maintained. Furthermore, no tumor recurrence occurred in any patient. ADM is a valuable posterior lamellar material for the full-thickness reconstruction of eyelid defects after the resection of malignant tumors on the eyelids.
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Affiliation(s)
- Tao Ma
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Lianji Xu
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yanming Chen
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Junyi Zhang
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xinming Han
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Yewei Si
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Shuang Wang
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Libin Jiang
- Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing, China
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Facial Cosmetic Surgery. J Oral Maxillofac Surg 2023; 81:E300-E324. [PMID: 37833027 DOI: 10.1016/j.joms.2023.06.022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/15/2023]
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Panuganti A, Sahu MP, Rao N, Malhotra M. Chondrocutaneous conchal graft for optimal reconstruction of full-thickness lower eyelid defect: a reconstructive challenge. BMJ Case Rep 2022; 15:e247825. [PMID: 35580948 PMCID: PMC9114859 DOI: 10.1136/bcr-2021-247825] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 12/24/2022] Open
Abstract
Non-melanoma skin cancers of the head and neck region require optimal management encompassing oncological safety, minimal functional and cosmetic morbidity. The eyelid reconstruction poses a reconstructive challenge as it should include both anatomical and functional integrity. Full-thickness eyelid defects post resection can be managed with chondrocutaneous grafts. We present to you a case of a man in his 70s, who presented with left lower eyelid squamous cell carcinoma, who had a full-thickness eyelid defect, post ablative resection. Composite chondrocutaneous conchal graft with forehead flap was used to provide adequate functional and cosmetic outcomes. The patient has normal vision, with no exposure keratitis and complications.
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Affiliation(s)
- Achyuth Panuganti
- Otorhinolaryngology & Head-Neck Surgery & Oncology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | - Madhu Priya Sahu
- Otorhinolaryngology & Head-Neck Surgery & Oncology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
| | - Neeraj Rao
- Plastic Surgery, All India Institute of Medical Sciences Rishikesh, Rishikesh, India
| | - Manu Malhotra
- Otorhinolaryngology & Head-Neck Surgery & Oncology, All India Institute of Medical Sciences Rishikesh, Rishikesh, Uttarakhand, India
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Ma T, Xu L, Chen Y, Zhang J, Han X, Jiang L. Full-thickness lower eyelid defect reconstruction using a pedicle rotation temporal flap and Acellular Human Dermis Graft (Alloderm). J Plast Reconstr Aesthet Surg 2022; 75:3414-3419. [PMID: 35680536 DOI: 10.1016/j.bjps.2022.04.082] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2022] [Revised: 03/11/2022] [Accepted: 04/26/2022] [Indexed: 11/19/2022]
Abstract
The aim of this research was to prospectively examine the combination of a pedicled temporal rotation flap with an acellular human dermal graft technique for intermediate-sized lower eyelid defect reconstruction. Pedicled temporal rotation flaps based on the orbicularis oculi muscle were used to reconstruct the anterior lamella of lower eyelid defects in six patients (five males and one female) while the posterior lamella was reconstructed using an acellular human dermis graft (Alloderm). Flap survival at 6 months was 100%. The functionality and cosmetic results of the technique were evaluated, and corneal protection was achieved. The texture and color of the reconstructed eyelid matched the surrounding skin, and neither pain nor corneal irritation was reported. The donor site scar healed well and was inconspicuous in all cases. Furthermore, no recurrence of malignancy was observed. The combination of a temporal rotational flap with an acellular human dermal graft is the key points. This technique could be ideal for the reconstruction of intermediate-sized full-thickness lower eyelid defects.
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Affiliation(s)
- Tao Ma
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Lianji Xu
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Yanming Chen
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Junyi Zhang
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Xinming Han
- Department of Plastic and Reconstructive Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing 100730, China
| | - Libin Jiang
- Eye Center, Beijing Tongren Hospital, Capital Medical University, Beijing Ophthalmology and Visual Sciences Key Laboratory, Beijing 100730, China.
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Gümüş N. Three-Dimensional Tarsal Plate Reconstruction Using Lower Lateral Cartilage of the Nose. Ann Plast Surg 2022; 88:406-409. [PMID: 35312649 DOI: 10.1097/sap.0000000000003097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Many types of graft tissue have been used to reconstruct the posterior lamella of the eyelids in cases of full-thickness defect, lid retraction, and loss of lower lid stability. In this study, lower lateral cartilage of the nose was used for the reconstruction of posterior lamella of the eyelids, which mimics the tarsal plate in shape, thickness, and size. MATERIAL AND METHODS This study included 10 patients who underwent lid reconstruction to support tarsal plate strength and repair full-thickness defects of the eyelids due to tumor excision and trauma. While anterior lamella was reconstructed with local or regional flaps, posterior lamella was repaired by using either chondromucosal or chondral graft of the lower lateral cartilage of the nose. Graft harvesting was performed on the inner surface of the alar rim by turning it inside out. RESULTS Cartilage grafts were sufficient to reconstruct the tarsal plate in all of the patients having eyelid defects of various sizes. In 3 patients, horizontal half of the eyelid was defective, in 3 patients 3/4, and in 2 patients 4/5 of the lids were missing. The inferior eyelid was totally reconstructed in 1 patient. Surgical outcomes provided good lid symmetry and esthetics, patient satisfaction, and proper lid function without any nasal deformity, incision scar, or discomfort. CONCLUSIONS Ala graft provides a thin, pliable, and curved cartilage for the eyelid reconstruction. It has a high similarity with the anatomy of the tarsal plate, making it adaptable to the convex surface of the eyeball, and making 3 dimensional repair possible.
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Affiliation(s)
- Nazim Gümüş
- From the Plastic, Reconstructive and Aesthetic Surgery Department, Mersin University Medical Faculty, Mersin, Turkey
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Reconstruction of Large Upper Eyelid Defects Using the Reverse Hughes Flap Combined With a Sandwich Graft of an Acellular Dermal Matrix. Ophthalmic Plast Reconstr Surg 2021; 37:S27-S30. [PMID: 32773514 DOI: 10.1097/iop.0000000000001779] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To investigate the usefulness of the reverse Hughes flap procedure combined with a sandwich graft of an acellular dermal matrix for reconstruction of large full-thickness defects of upper eyelids after cancer excision. METHODS Clinical data were obtained from patients who underwent upper eyelid reconstruction using a reverse Hughes flap combined with a sandwich graft of an acellular dermal matrix (AlloDerm) as a tarsal substitute. The tarsoconjunctival flap of the donor lower eyelid was mobilized to reconstruct the posterior lamella, and acellular dermal matrix was grafted onto the tarsoconjunctival flap. A skin-orbicularis muscle flap superior to the defect was advanced to cover the acellular dermal matrix graft, followed by application of lid crease formation sutures to prevent postoperative entropion. The tarsoconjunctival pedicle was divided 3-8 weeks after the surgery. RESULTS Six patients with sebaceous carcinoma were included, and all had ≥70% full-thickness upper eyelid defects after tumor excision. After a median follow-up of 40 months (range 6-62 months), all 6 showed satisfactory functional and cosmetic outcomes. Tumor recurrence, exposure keratopathy, upper eyelid entropion, persistent use of bandage contact lenses, lower eyelid deformity, and dermal matrix-related complications were not observed by the last follow-up. CONCLUSIONS Reverse Hughes flap combined with a sandwich graft of an acellular dermal matrix as a tarsal substitute was successful in reconstructing large upper eyelid defects. Acellular dermal matrix graft and lid crease formation sutures enhance marginal stability and prevent postoperative entropion of the reconstructed upper eyelid.
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Barin EZ, Cinal H. Total and near-total lower eyelid reconstruction with prefabricated orbicularis oculi musculocutaneous island flap. Dermatol Ther 2020; 33:e13372. [PMID: 32246579 DOI: 10.1111/dth.13372] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/24/2020] [Accepted: 04/01/2020] [Indexed: 11/30/2022]
Abstract
Full thickness lower lid defects are frequently encountered during daily practice. The unique anatomy of the eyelids hinders reconstructive efforts. The aim of the study is to develop an effective and easy procedure for the reconstruction of full thickness defects of the lower eyelid. Here we present six cases, which we treated with an orbicularis oculi musculocutaneous island flap prefabricated with a chondrocutaneous graft. Five of the six cases suffered from tumors, while one had congenital coloboma of the lower lid. A chondrocutaneous graft harvested from the ear was placed under the orbicularis oculi musculocutaneous flap. Three weeks later, the defect was created and the prefabricated flap was transposed to the defect. Two cases had superficial distal skin loss and one had prolonged oedema. No major complication or tumor recurrence was seen. Using this method, the principle "replace with like" is fulfilled. Orbicularis oculi musculocutaneous island flap prefabricated with postauricular chondrocutaneous composite graft seems to be a feasible method for the reconstruction of full thickness defects of the lower eyelid with its low donor morbidity and good outcomes.
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Affiliation(s)
- Ensar Zafer Barin
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Ataturk University, Erzurum, Turkey
| | - Hakan Cinal
- Department of Plastic Reconstructive and Aesthetic Surgery, Faculty of Medicine, Bulent Ecevit University, Zonguldak, Turkey
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Fin A, De Biasio F, Lanzetta P, Mura S, Tarantini A, Parodi PC. Posterior lamellar reconstruction: a comprehensive review of the literature. Orbit 2019; 38:51-66. [PMID: 29781746 DOI: 10.1080/01676830.2018.1474236] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
The aim of the review is to describe the different techniques and materials available to reconstruct the tarsoconjunctival layer of the eyelid; to analyze their indications, advantages, and disadvantages. We searched the Cochrane, PubMed, and Ovid MEDLINE databases for English articles published between January 1990 and January 2017 using variations of the following key words: "posterior lamella," "eyelid reconstruction," "tarsoconjunctival," "flap," and "graft." Two reviewers checked the abstracts of the articles found to eliminate redundant or not relevant articles. The references of the identified articles were screened manually to include relevant works not found through the initial search. The search identified 174 articles. Only a few articles with a therapeutic level of evidence were found. Techniques for the posterior lamellar reconstruction can be categorized as local, regional, and distant flaps; tarsoconjunctival, heterotopic, homologous, and heterologous grafts. Several techniques and variations on the techniques exist to reconstruct the posterior lamella, and, for similar indications, there's no evidence of the primacy of one over the other. Defect size and location as well as patient features must guide the oculoplastic surgeon's choice. The use of biomaterials can avoid possible complications of the donor site.
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Affiliation(s)
- Alessandra Fin
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Fabrizio De Biasio
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Paolo Lanzetta
- b Clinic Department of Ophthalmology , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Sebastiano Mura
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Anna Tarantini
- b Clinic Department of Ophthalmology , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Pier Camillo Parodi
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
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Hufschmidt K, Camuzard O, Balaguer T, Baqué P, de Peretti F, Santini J, Bronsard N, Qassemyar Q. The infraorbital artery: From descriptive anatomy to mucosal perforator flap design. Head Neck 2019; 41:2065-2073. [PMID: 30684276 DOI: 10.1002/hed.25653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/06/2018] [Accepted: 01/03/2019] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND The terminal and perforating branches of the infraorbital artery (IOA) are poorly described. Its anatomical situation and mucosal component could provide an interesting donor site for mucosal reconstruction. The aims of the following study were to establish an anatomical description and to assess the feasibility of mucosal perforator flaps for eyelid and nasal reconstruction. METHODS Twenty-three fresh cadaver hemifaces were studied in order to perform an IOA anatomical classification by recording the artery's characteristics, its course, number, type, and diameter of terminal branches. We also examined the feasibility of local flaps for facial reconstruction. RESULTS We highlighted five different types of courses. All cadavers had at least one superior vestibular branch with a caliber of ≥0.4 mm. A pedicled flap arising from the vestibular branch was raised in all dissections. CONCLUSION The vestibular perforator flap based on the IOA seems to be a reliable flap in reconstruction of mucosal defects.
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Affiliation(s)
- Katharina Hufschmidt
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Olivier Camuzard
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Thierry Balaguer
- Department of Plastic and Reconstructive Surgery, University Hospital Nice, Nice, France
| | - Patrick Baqué
- Department of General and Emergency Surgery, University Hospital Nice, Nice, France
| | - Fernand de Peretti
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Joseph Santini
- Department of Head and Neck Surgery, University Hospital of Nice, Nice, France
| | - Nicolas Bronsard
- Department of Locomotor and Sport Surgery (IULS), University Hospital Nice, Nice, France
| | - Quentin Qassemyar
- Department of Plastic, Aesthetic and Reconstructive Surgery, Hospital Tenon, Paris, France
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Li Q. Lamellar rotation surgery: a new procedure for repairing upper eyelid defects. BMC Ophthalmol 2018; 18:291. [PMID: 30404607 PMCID: PMC6222999 DOI: 10.1186/s12886-018-0958-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2018] [Accepted: 10/24/2018] [Indexed: 12/04/2022] Open
Abstract
Background To report “Lamellar Rotation Surgery”,a new technique for repairing large and moderate full-thickness upper eyelid defects. Methods A two-stage technique is described in which a vertical incision is made in the tarsus of the lower eyelid with elevation of the lateral posterior lamella while sparing the lower eyelid orbicularis and skin to be rotated superiorly to form the reconstructed posterior lamella of the upper eyelid. Additionally, a lateral periosteal flap is used to reconstruct the lateral canthal tendon, and a McGregor procedure is used to reconstruct the anterior lamella of the upper eyelid. The flap is divided during a second-stage surgery at 3 months. Three cases are described to showcase this technique. Results Good functional and aesthetic results were achieved for the eyelids. Conclusions This new procedure may help to address the challenge of repairing full-thickness defects of the upper eyelid. Trial registration Registration number: ChiCTR1800018990, 20 Oct 2018, retrospectively registered. Electronic supplementary material The online version of this article (10.1186/s12886-018-0958-0) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Qingji Li
- Department of Oculoplastic and Reconstructive Surgery, Tianjin Aier Eye Hospital, No.102, Fukang Road, Nankai District, Tianjin, 300190, People's Republic of China.
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Long-Term Outcomes of Acellular Dermal Allograft as a Tarsal Substitute in the Reconstruction of Extensive Eyelid Defects. J Craniofac Surg 2018. [PMID: 29521763 DOI: 10.1097/scs.0000000000004464] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
PURPOSE To report the long-term outcomes of using acellular dermal allograft (ADA) as a tarsal substitute for reconstruction of large full-thickness eyelid defects where ipsilateral or contralateral eyelid donor tissue was either not available or tarsoconjunctival transfer was insufficient to cover the full extent of the defect. METHODS A retrospective review of a consecutive series of 10 patients between May 2003 and April 2012. Main outcome measures were anatomical and functional outcomes and complications. RESULTS The study cohort included 4 males and 6 females with a mean age of 48.1 years (range 31-64 years). Indications for reconstruction were extensive full-thickness eyelid defects (upper or lower or both) resulting from tumor excision (n = 6), traumatic eyelid defect (n = 2), electrical burn (n = 1), and eyelid necrosis (n = 1). The mean postoperative follow-up was 84.3 months (range 33-164 months). The reconstructive procedure included a variety of techniques using ADA as the posterior lamellar graft. Overall, 7 patients achieved excellent anatomical, cosmetic, and functional results. Reoperation was required in 3 patients (for postoperative upper lid retraction, upper lid entropion, and lower fornix reconstruction) despite acceptable initial results. There were no intraoperative complications, postoperative allergic or immunologic rejection associated with the use of allograft, nor any long-term sequelae. CONCLUSION The extensive upper and lower eyelid defects with large vertical component can be successfully repaired using ADA as a tarsal substitute. The results of our study with long-term follow-up indicate excellent functional and cosmetic outcomes with minimal morbidity.
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Surgical Treatment with Locoregional Flaps for the Eyelid: A Review. BIOMED RESEARCH INTERNATIONAL 2017; 2017:6742537. [PMID: 29226145 PMCID: PMC5684523 DOI: 10.1155/2017/6742537] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/20/2017] [Accepted: 08/15/2017] [Indexed: 11/29/2022]
Abstract
Reconstruction of the eyelids after skin cancer excision can be challenging. Surgical treatment options are multiple; deep anatomy knowledge of lamellar components is mandatory to choose the most adequate surgical planning. Eyelids' role in vision and social relationship is critical; both function and aesthetics are tough to restore. Using a flap provides a satisfying texture and colour match with adjacent tissues and ensures short contraction during healing; furthermore, grafts are sometimes necessary to achieve pleasing results. Hundreds of surgical techniques have been described aiming for eyelid reconstruction; in our paper, we want to provide for our audience the most reliable and useful procedures for subtotal and total eyelid reconstruction following NMSC full-thickness excision.
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Chang HH, Suh E, Fortes BH, Zheng F, Cheng AM. Forehead galeal pericranial flap for single-staged total upper eyelid reconstruction in sebaceous gland carcinoma excision. Int Med Case Rep J 2017; 10:309-312. [PMID: 28919826 PMCID: PMC5592914 DOI: 10.2147/imcrj.s141373] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose To present a successful case of single-staged total upper eyelid reconstruction after sebaceous gland carcinoma excision by using forehead galeal pericranial flap. Observations An 80-year-old female with a progressively enlarged left upper eyelid mass presented with ocular irritation, blurred vision, and gritty sensation despite topical antibiotics treatment. This multinodular mass involved the left total upper eyelid, compromised corneal surface integrity, and caused complete ptosis. Excisional biopsy confirmed advanced sebaceous gland carcinoma, which was followed by extensive excision. The resultant total upper eyelid defect was reconstructed by a forehead galeal pericranial flap accompanied by anterior and posterior lamellar grafts. For the 34-month follow-up period, patient remained symptom-free without tumor recurrence and achieved acceptable cosmetic outcome. Conclusion The forehead galeal pericranial flap appears to be effective as single-staged total upper lid reconstruction following extensive sebaceous gland carcinoma excision to restore eyelid function, avoid corneal exposure, and achieve acceptable cosmesis.
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Affiliation(s)
- Hui-Hsiu Chang
- Division of Plastic and Reconstructive Surgery, Department of Surgery, National Taiwan University Hosiptal Yunlin Branch, Yunlin, Taiwan.,Department of Industrial Engineering and Management, National Yunlin University of Science and Technology, Yunlin, Taiwan
| | - Edward Suh
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Blake H Fortes
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Franklin Zheng
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA
| | - Anny Ms Cheng
- Department of Ophthalmology, Florida International University, Herbert Wertheim College of Medicine, Miami, FL, USA.,Ocular Surface Center, Miami, FL, USA
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Lu GN, Pelton RW, Humphrey CD, Kriet JD. Defect of the Eyelids. Facial Plast Surg Clin North Am 2017; 25:377-392. [DOI: 10.1016/j.fsc.2017.03.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Yamamoto N, Ogi H, Yanagibayashi S, Yoshida R, Takikawa M, Nishijima A, Kiyosawa T. Eyelid Reconstruction Using Oral Mucosa and Ear Cartilage Strips as Sandwich Grafting. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2017; 5:e1301. [PMID: 28507862 PMCID: PMC5426881 DOI: 10.1097/gox.0000000000001301] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2016] [Accepted: 02/24/2017] [Indexed: 01/04/2023]
Abstract
Background: The eyelid structure can be divided into an inner layer and an outer layer. Reconstruction of a full-thickness eyelid defect is accomplished by full-thickness composite tissue transfer or combined layered reconstruction. We present a new technique for inner layer reconstruction using ear cartilage and oral mucosa. Methods: The oral mucosa graft is harvested from the inner side of the lower lip to fit the defect size and shape. The ear cartilage graft is harvested as a rectangular strip. The harvested mucosa is sutured to the defect margin and the cartilage strip graft is interposed to the defect. Finally, the outer layer of the defect is covered with skin flaps. Consequently, the ear cartilage graft is sandwiched between the mucosa graft and the skin flap. Results: We used this technique for the reconstruction of 13 full-thickness eyelid defects of various locations, sizes, and shapes. Ten cases involved the lower eyelid, 2 cases involved the lower eyelid including the medial canthus, and 1 case involved the upper eyelid. The oral mucosa graft survived in all patients. The reconstructions were successful and there were no postoperative reports of conjunctival or corneal irritation. Conclusions: The present technique using a combination of an ear cartilage strip graft and oral mucosa graft is an easy and versatile technique for reconstruction of inner layer eyelid defects. We believe that the beneficial effects of tears, which are richly oxygenated, improved survival of the grafted mucosa.
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Affiliation(s)
- Naoto Yamamoto
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
| | - Hiroyuki Ogi
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
| | - Satoshi Yanagibayashi
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
| | - Ryuichi Yoshida
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
| | - Megumi Takikawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
| | - Akio Nishijima
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
| | - Tomoharu Kiyosawa
- Department of Plastic and Reconstructive Surgery, New Tokyo Hospital, Chiba, Japan; Department of Plastic and Reconstructive Surgery, Asakadai Central General Hospital, Saitama, Japan; and Department of Plastic and Reconstructive Surgery, National Defense Medical College, Saitama, Japan
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Reconstruction of Combined Upper and Lower Eyelid Defects in a Patient With Lentigo Maligna. Dermatol Surg 2017; 43 Suppl 1:S111-S114. [PMID: 28346250 DOI: 10.1097/dss.0000000000000787] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Failed Cartilaginous Grafts in the Eyelid: A Retrospective Clinicopathological Analysis of 5 Cases. Ophthalmic Plast Reconstr Surg 2016; 32:347-53. [DOI: 10.1097/iop.0000000000000540] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Toft PB. Reconstruction of large upper eyelid defects with a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft. Orbit 2015; 35:1-5. [PMID: 26636623 DOI: 10.3109/01676830.2015.1078372] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Accepted: 07/27/2015] [Indexed: 06/05/2023]
Abstract
PURPOSE To review and present the results of a one-step method employing a free tarsal plate graft and a myocutaneous pedicle flap plus a free skin graft for reconstruction of large upper eyelid defects after tumour surgery. METHODS This was a retrospective case-series of 8 patients who underwent reconstruction of the upper eyelid after tumour removal. The horizontal defect involved 50-75% of the lid (3 pts.), more than 75% (3 pts.), and more than 75% plus the lateral canthus (2 pts.). The posterior lamella was reconstructed with contralateral upper eyelid tarsal plate. The anterior lamella was reconstructed with a laterally based myocutaneous pedicle flap in 7 patients, leaving a raw surface under the brow which was covered with a free skin graft. In 1 patient with little skin left under the brow, the anterior lamella was reconstructed with a bi-pedicle orbicularis muscle flap together with a free skin graft. RESULTS All patients healed without necrosis, did not suffer from lagophthalmos, achieved reasonable cosmesis, and did not need lubricants. In one patient, a contact lens was necessary for three weeks because of corneal erosion. One patient still needs a contact lens 3 months after excision to avoid eye discomfort. CONCLUSION Large upper eyelid defects can be reconstructed with a free tarsal plate graft and a laterally based myocutaneous pedicle flap in combination with a free skin graft. Two-step procedures can probably be avoided in most cases.
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Affiliation(s)
- Peter B Toft
- a Department of Ophthalmology, Rigshospitalet , University of Copenhagen , Copenhagen , Denmark
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Belmajdoub M, Jacomet PV, Benillouche P, Galatoire O. Reconstruction palpébrale supérieure par la méthode de Cutler-Beard : évaluation rétrospective de 16 cas. J Fr Ophtalmol 2015; 38:607-14. [DOI: 10.1016/j.jfo.2014.11.016] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2014] [Revised: 11/09/2014] [Accepted: 11/25/2014] [Indexed: 10/23/2022]
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A Crossover Reconstruction Between the Forehead Expansion and Upper Eyelid Skin. J Craniofac Surg 2015. [PMID: 26221850 DOI: 10.1097/scs.0000000000002008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In cosmetic surgery, the authors have successfully used forehead expansion for reconstruction of the upper eyelid, and have found it to be indispensable for reconstruction of the upper eyelid. In such an operation, preserving the eyebrow is often a problem, and they suggest an approach in 2 stages, which allows us to both save the eyebrow and use the expander flap at the same time. In the last 6 years, they have performed 5 forehead expansions for total upper eyelid skin reconstruction, achieving very good aesthetic outcomes. METHODS Firstly, the authors measure the defect and choose an appropriate expander implant for the forehead. Secondly, they cut out the pathologically changed-turned red or scarred-skin to protect the eyebrow. Next they get out the tissue expander and use the tissue flap to repair the upper eyelid defect, while the eyebrow is under the expander flap, covered by skin, which they originally cut from the upper eyelid. Three weeks later they can cut down the pedicel and the flap becomes the new upper eyelid skin. RESULTS The authors find that the new upper eyelid skin may be vascularized by dermatological vessels from the expander flap. The forehead expander flap is reliable and particularly well suited for an upper eyelid, with numerous advantages. In this way, they make maximal use of the expander flap and no additional incision is needed. LEVEL OF EVIDENCE Level IV, therapeutic study.
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Gao Q, Hu B, Ning Q, Ye C, Xie J, Ye J, Gao C. A primary study of poly(propylene fumarate)-2-hydroxyethyl methacrylate copolymer scaffolds for tarsal plate repair and reconstruction in rabbit eyelids. J Mater Chem B 2015; 3:4052-4062. [PMID: 32262627 DOI: 10.1039/c5tb00285k] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Eyelid reconstruction includes anterior lamella reconstruction and posterior lamella reconstruction. As an important skeletal component of the posterior lamella, tarsal plates repair is the key issue for eyelid reconstruction. Presently, neither traditional surgery nor autograft/allograft has achieved satisfactory repair effects. Poly(propylene fumarate)-co-2-hydroxyethyl methacrylate (PPF-HEMA) networks with mass ratios of 1 : 0.5, 1 : 1 and 1 : 2 were synthesized and used as the tarsal substitute in this study. Their chemical compositions, swelling ability, and mechanical properties were characterized. Porous scaffolds were fabricated by a gelatin particle leaching method. The in vitro studies of cytotoxicity on human dermal fibroblasts (HDFs) and degradation demonstrated that PPF-HEMA scaffolds did not have noticeable cell cytotoxicity and their degradation rates correlated with the ratio of PPF to HEMA. The PPF-HEMA networks, with mass ratios of 1 : 1 and 1 : 2, and an ADM control were implanted in rabbits with tarsal plate defects for in vivo biocompatibility and degradation behavior evaluation. PPF-HEMA scaffolds provided satisfactory repair results with mild tissue response and biocompatibility to fibroblast growth and fibrous capsulation compared to the ADM control. The tissue compatible and biodegradable PPF-HEMA networks with elastic mechanical properties were proven to be a suitable candidate for tarsal repair.
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Affiliation(s)
- Qi Gao
- Department of Ophthalmology, the Second Affiliated Hospital of Zhejiang University, College of Medicine, Hangzhou, Zhejiang 310009, China.
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Emesz M, Krall E, Nischler C, Rasp M, Dexl AK, Bauer F, Grabner G, Arlt EM. [Hughes' operation and combined procedures]. Ophthalmologe 2015; 111:448-53. [PMID: 23949884 DOI: 10.1007/s00347-013-2918-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND The Hughes procedure is a standard and widely used technique for lower eyelid reconstruction. This paper presents the results of 55 patients who underwent reconstruction of the anterior and posterior lamella with the Hughes procedure at the University eye clinic in Salzburg between 2002 and 2012. PATIENTS AND METHODS This study included 55 patients who underwent lower eyelid reconstruction performed with the Hughes procedure including a full skin graft. In 95 % of patients (52/55) this method was performed after tumor resection. The defect size of the lower lid was at least 10 mm horizontally and ranged between 10 and 15 mm. Of the patients three were treated with a combined Hughes and Tenzel procedure whereas in five cases the Hughes procedure was combined with an autologous tarsoconjunctival flap of the contralateral upper lid and a local full skin rotational flap. RESULTS In 42 out of 55 patients both the eyelid function as well as the restoration of good cosmesis could be achieved. In 6 out of the remaining 13 patients suffering from minor complications, the function and cosmesis were restored after secondary minor surgery or additional conservative treatment. For six patients, further reconstructive surgery was necessary and one experienced a major complication in the form of a recurrence of basal cell carcinoma necessitating exenteration. CONCLUSIONS The Hughes procedure is a well-suited technique for eyelid reconstruction of shallow defects extending beyond 10 mm horizontally and involving up to 100 % of the eyelid. The latter require a combined procedure such as the Hughes procedure and an autologous tarsoconjunctival flap and skin graft.
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Affiliation(s)
- M Emesz
- Universitätsaugenklinik Salzburg, Paracelsus Medizinische Privatuniversität, Müllner Hauptstr. 48, 5020, Salzburg, Österreich,
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Ahuja RB, Chatterjee P, Gupta GK, Shrivastava P. Total upper eyelid reconstruction by single staged malar-cheek flap. Indian J Plast Surg 2014; 47:116-9. [PMID: 24987215 PMCID: PMC4075198 DOI: 10.4103/0970-0358.129637] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report a case of total upper eyelid reconstruction by a new technique after excision of an eyelid tumour. The eyelid was reconstructed by a horizontal, laterally based flap from just under the lower eyelid combined with a chondro-mucosal graft from the nasal septum. Surgical outcome was an excellent aesthetically reconstructed eyelid, which was mobile and properly gliding on the globe to achieve complete eye closure.
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Affiliation(s)
- Rajeev B Ahuja
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
| | - Pallab Chatterjee
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
| | - Gaurav K Gupta
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
| | - Prabhat Shrivastava
- Department of Burns & Plastic Surgery, Lok Nayak Hospital and Associated Maulana Azad Medical College, New Delhi, India
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Yüce S, Demir Z, Selçuk CT, Celebioğlu S. Reconstruction of periorbital region defects: A retrospective study. Ann Maxillofac Surg 2014; 4:45-50. [PMID: 24987598 PMCID: PMC4073462 DOI: 10.4103/2231-0746.133077] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Background: Although the periorbital region forms less than 1% of the total body surface, it has a very complex anatomy; therefore, it requires a detailed approach. In this work, we aim to present the clinical applications and related literature for the algorithm of the technique which will be applied, according to the location of the defect, in choosing the surgery treatment method. Factors affecting the results and different treatment methods of the anatomical region, including its difficult reconstruction, will also be included. Materials and Methods: A review of 177 periorbital region defect reconstructions was performed. Results: As a treatment method, in 76 (43%) patients primary closure was chosen, 39 (22%) patients had grafts and in 62 (35%) patients a flap was chosen as a treatment alternative. With respect to postoperative complications, there were a total of 6 (3.38%) patients observed with venous congestion. In 11 (6.21%) patients ectropion developed, in 1 (0.56%) patient minimal space between the eyelids while monitoring recovery was observed and in 1 (0.56%) patient, flap loss was observed due to a circulatory disorder. Conclusions: The aim of reconstruction is to repair the defect suitable to normal physiological and anatomical values. As a result, before the surgical treatments in this difficult anatomical region, the defect width and anatomical localization must be evaluated. The most suitable reconstruction method must be identified, using an evaluation of the algorithm and the required functional and esthetical results can be obtained with intraoperative flexible behavior and a change of method, when necessary.
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Affiliation(s)
- Serdar Yüce
- Department of Plastic, Reconstructive and Aesthetic Surgery, Faculty of Medicine, Yuzuncu Yıl University, Van, Turkey
| | - Zühtü Demir
- Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
| | | | - Selim Celebioğlu
- Dışkapı Yıldırım Beyazıt Education and Research Hospital, Ankara, Turkey
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Supratrochlear island flap for reconstruction of the periorbital and nasal defects. EUROPEAN JOURNAL OF PLASTIC SURGERY 2014. [DOI: 10.1007/s00238-013-0895-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Lower lid reconstruction utilizing auricular conchal chondral-perichondral tissue in patients with neoplastic lesions. BIOMED RESEARCH INTERNATIONAL 2013; 2013:837536. [PMID: 23865069 PMCID: PMC3705807 DOI: 10.1155/2013/837536] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 06/08/2013] [Indexed: 02/05/2023]
Abstract
Purpose. To assess surgical outcomes of lower lid reconstruction surgery using auricular conchal tissue. Methods. This prospective study included 20 patients that underwent reconstructive lower lid surgery using autologous auricle chondral-perichondral graft tissue. Auricle tissue was used to provide adequate support and protection with similar conjunctiva tarsal structures on overlying soft tissues in patients with pathologic inferior lid tissue loss requiring reconstructive surgery. Biopsies with histopathology and cytology analysis were taken after 1 year. Cytology analysis using CK19 was used to confirm newly formed conjunctiva overlying the graft. Results. All patients showed no graft rejection. Surgical outcomes were generally good, with minimal or no ocular complications. 16 of 20 patients had excellent results, showing good lid symmetry and esthetics, minimal auricular discomfort, patient satisfaction and proper lid function. Surgical outcomes were highly dependent on proper post-op conjunctiva formation. All patients were positive for CK19, thus indicating proper conjunctiva tissue formation. Conclusions. Lower lid reconstruction surgery using auricular chondral-perichondral conchal tissue is a good alternative in patients with neoplastic lesions. Autologous chondral-perichondral tissue provides good functional and mechanical support in the reconstructed lid, thus reducing the risks of ectropion and corneal exposure and ensuring a protected ocular surface.
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Reconstruction of total upper eyelid with prefabricated capsule-lined advancement flaps. J Craniofac Surg 2013; 24:1038-41. [PMID: 23714941 DOI: 10.1097/scs.0b013e3182801983] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND A total upper eyelid defect is a rare problem that may result from tumor excision, trauma, or burns. Reconstruction of a total upper eyelid defect involves the reconstruction of 2 fundamental elements: anterior and posterior lamellae. Because an expander capsule looks like the palpebral conjunctiva with a moist, smooth, white glistening appearance, its use was investigated in the repair of total upper eyelid defects in rabbits. METHODS Sixty-six tissue expanders with the autogeneic conchal chondro-grafts were implanted into the foreheads of 66 rabbits. After 6 to 8 weeks, the sandwich-prefabricated advancement flaps were designed to reconstruct rectangular excisions of the upper eyelid. The cartilage was preliminarily inserted in a flap, formed by tissue expansion, and then transferred to an upper eyelid defect in the rabbit. Histopathology was evaluated at 3 days, 1 week, 2 weeks, 1 month, 2 months, and 4 months after reconstruction. The upper palpebral length was measured after 4 months of reconstruction as a 1-dimension reference point of flap contracture. RESULTS No edema, congestion, infection, corneal damage, or necrosis were observed during the reconstructions. Histopathologic studies revealed that the long-term capsule had a normal conjunctiva-like appearance with a stratified columnar epithelium. The average shortening, measured as the length between inner to outer canthal folds, was inconspicuous. CONCLUSIONS The expander capsule has the potential to act as an effective posterior lamellar substitute of eyelid in a rabbit model. Further studies should be undertaken to see if this represents a good model for a potential human clinical application.
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Angular vessels as a new vascular pedicle of an island nasal chondromucosal flap: Anatomical study and clinical application. Exp Ther Med 2012; 5:751-756. [PMID: 23408230 PMCID: PMC3570236 DOI: 10.3892/etm.2012.860] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2012] [Accepted: 11/14/2012] [Indexed: 11/20/2022] Open
Abstract
Successful eyelid reconstructions have been reported when using an axial nasal chondromucosal flap based on the dorsal nasal artery. The present study aimed to present a detailed anatomical description of the blood supply of the lateral nasal region and the angular artery, in order to propose the angular vessels as a new vascular pedicle for the island nasal chondromucosal flap. A total of 11 cadavers (22 hemi-faces) were examined. Observations with regard to the origin, course and distribution patterns of the angular artery were recorded. Based on the anatomical study findings, the angular vessels were proposed as a vascular source for the island nasal chondromucosal flap. Observations with regard to the varying origins of the angular artery were categorized into four types. The course of the angular artery along the nasojugal fold was constant. The angular artery branched off into the upper two-thirds of the lateral nasal region and anastomosed with the other vascular branches on the nasal dorsum. Clinically, reconstruction of a full-thickness defect of the lower eyelid was successfully performed by using this composite flap based on the angular vessels and an adjacent orbicularis oculi myocutaneous flap. Satisfactory esthetic outcomes were obtained for the donor and recipient sites. The angular artery is a good vascular source for an island nasal chondromucosal flap. The flap may be created safely and successfully in clinic. Island nasal chondromucosal flaps and nasolabial groove skin flaps based on the angular vessels may be designed simultaneously for use on full-thickness defects of the eyelid.
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Saito A, Saito N, Furukawa H, Hayashi T, Oyama A, Funayama E, Minakawa H, Yamamoto Y. Reconstruction of periorbital defects following malignant tumour excision: A report of 50 cases. J Plast Reconstr Aesthet Surg 2012; 65:665-70. [DOI: 10.1016/j.bjps.2011.09.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/24/2011] [Accepted: 09/06/2011] [Indexed: 11/28/2022]
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Upper eyelid defect by dog bite reconstructed by an ipsilateral advanced tarsoconjunctival flap with skin graft. EUROPEAN JOURNAL OF PLASTIC SURGERY 2012. [DOI: 10.1007/s00238-010-0509-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Single-stage frontalis muscle flap for full-thickness reconstruction of the upper eyelid. J Craniofac Surg 2011; 22:1762-4. [PMID: 21959427 DOI: 10.1097/scs.0b013e31822e6321] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Full-thickness upper eyelid defects present a reconstructive challenge. Defects greater than 50% of the upper eyelid have traditionally been reconstructed with bulky full-thickness forehead flaps, Cutler-Beard flaps, Mustarde eyelid switches, and cheek rotation advancements, all mandating a second-stage surgical procedure. We propose a novel technique for full-thickness upper eyelid reconstruction based on a frontalis muscle flap elevated from the resection defect, thus resulting in no additional forehead scar. METHODS Our patient is a 48-year-old woman with an enlarging right upper eyelid sebaceous cell carcinoma. A subsequent single-stage resection resulted in a medial full-thickness defect of 75% of the upper eyelid. The lateral and medial canthi were preserved. A palatal mucoperiosteal graft was harvested for the reconstruction of the posterior lamella. Dissection was carried through the excision defect in a preseptal plane over the supraorbital rim and subcutaneously over the frontalis muscle. A caudally pedicled frontalis muscle flap was elevated and inset to the defect edges with mild tension. Reconstruction of the skin defect of the upper eyelid was completed with a full-thickness preauricular skin graft. RESULTS The patient had no complications and demonstrated good function and aesthetic result at 15 weeks and at 9 months postoperatively. CONCLUSIONS Frontalis muscle flap-based reconstruction offers a viable option for upper eyelid defects that are full thickness and encompass more than 50% of the eyelid. We obtained a functionally and aesthetically pleasing outcome with this single-stage procedure using a preexisting incision with minimal donor-site morbidity.
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Rosa J, Casal D, Moniz P. Upper eyelid reconstruction with a horizontal V–Y myotarsocutaneous advancement flap. J Plast Reconstr Aesthet Surg 2010; 63:2013-7. [DOI: 10.1016/j.bjps.2010.01.026] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2009] [Revised: 01/20/2010] [Accepted: 01/22/2010] [Indexed: 11/24/2022]
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Guidelines for reconstruction of the eyelids and canthal regions. J Plast Reconstr Aesthet Surg 2010; 63:1420-33. [DOI: 10.1016/j.bjps.2009.05.035] [Citation(s) in RCA: 58] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/06/2009] [Accepted: 05/18/2009] [Indexed: 11/20/2022]
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Morley AM, deSousa JL, Selva D, Malhotra R. Techniques of Upper Eyelid Reconstruction. Surv Ophthalmol 2010; 55:256-71. [DOI: 10.1016/j.survophthal.2009.10.004] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2009] [Revised: 10/05/2009] [Accepted: 10/06/2009] [Indexed: 10/20/2022]
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Abstract
PURPOSE Repair of large upper eyelid defects can be accomplished by both 1-stage and 2-stage techniques some of which are complicated and time consuming. I here present a simple 1-stage technique for upper eyelid reconstruction. METHODS The records and the peroperative and postoperative photographs of two patients who underwent reconstruction of large full-thickness upper eyelid defects after tumor removal were reviewed. The posterior lamella was reconstructed with lip mucosa in one patient and with a hard palate graft in the other. The anterior lamella was reconstructed with a myocutaneous pedicle flap from the remaining upper eyelid with its base medially or laterally. The resulting skin defect under the eyebrow was covered by a free skin graft from the contra lateral upper eyelid. RESULTS In both patients the flap healed without necrosis or any other complications. In the case where the posterior lamella was reconstructed with lip mucosa the cosmetic appearance was excellent, and the cornea remained unaffected throughout the postoperative period. In the case where a hard palate graft was used the cosmetic appearance was good, but the corneal epithelium developed an edema and a soft contact lens was needed. The visual acuity was 20/20 and 20/40, respectively, 3 months postoperatively. CONCLUSION Large upper eyelid defects can successfully be reconstructed by a pedicle flap from the infra brow area, which subsequently is covered by a free skin graft.
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Affiliation(s)
- Peter B Toft
- The Eye Clinic, Faculty of Health Sciences, University of Copenhagen, Rigshospitalet, Copenhagen, Denmark.
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The radix nasi island flap: a versatile musculocutaneous flap for defects of the eyelids, nose, and malar region. J Craniofac Surg 2009; 20:516-21. [PMID: 19305249 DOI: 10.1097/scs.0b013e3180f611c8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
A versatile musculocutan flap from the radix nasi region, the radix nasi island flap, is described. The flap has an axial blood supply derived from the dorsal nasal branch of the ophthalmic artery which is anastomosed to the terminal branch of the facial artery. The flap includes the skin, subcutaneous tissue, and procerus muscle. Ten patients, aged 50 to 86 years, have been reconstructed with this flap for defects in the nose (in 4 cases), midface (in 4 cases) and lower eyelids (in 2 cases). The mean flap size was 17 x 23 mm (range: 15 x 20 to 20 x 27 mm). All flaps fully survived. Additional complications and morbidity were not observed. The donor sites were closed a primarily closure in all cases. Follow-up ranged from 3 to 12 months (mean: 8.2 months). The radix nasi flap is a safe flap, has minimal donor site morbidity, and is especially suited for nasal and midface reconstruction in terms of attaining a suitable color and thickness.
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Upper eyelid reconstruction with forehead galeal flap. J Plast Reconstr Aesthet Surg 2009; 62:901-5. [DOI: 10.1016/j.bjps.2007.11.055] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Revised: 10/09/2007] [Accepted: 11/04/2007] [Indexed: 11/21/2022]
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O'Donnell BA, Mannor GE. Oculoplastic surgery for upper eyelid reconstruction after cutaneous carcinoma. Int Ophthalmol Clin 2009; 49:157-172. [PMID: 20348863 DOI: 10.1097/iio.0b013e3181b88b2d] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Affiliation(s)
- Brett A O'Donnell
- North Shore Medical Centre, 66 Pacific Highway, St. Leonards 2065, NSW, Australia
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Comparative Analysis of the Influence of Perichondrium on Conjunctival Epithelialization on Conchal Cartilage Grafts in Eyelid Reconstruction: Experimental Study in Rabbits. Plast Reconstr Surg 2009; 123:55-63. [PMID: 19116536 DOI: 10.1097/prs.0b013e3181904b6d] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Full-Thickness Lower Eyelid Reconstruction With a Conchal Chondro-Perichondral Graft and Local Coverage With Mio-Cutaneous Flaps—Our Divisional Experience. J Oral Maxillofac Surg 2008; 66:1826-32. [DOI: 10.1016/j.joms.2007.08.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2007] [Accepted: 08/28/2007] [Indexed: 10/21/2022]
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Abstract
The forehead skin has the same color and texture as the periorbital region as well as the other parts of the face. The forehead is a local flap donor area for the reconstruction of full-thickness periorbital defects. This report presents eight cases in which full-thickness defects resulting from tumor resection have been repaired with supraorbital artery island flaps. Of eight patients, one was female and the rest were male with a mean age of 72.8 years (range, 64-88 years). Defects were located in the medial canthal region, lateral canthal region, glabella, and lateral part of the orbita. The flaps ranged from 2 x 3 cm to 6 x 7 cm in size. The patients were followed for 7 to 18 months. No complications occurred, except for decreased sensation on the forehead, and trapdoor deformity was seen in one case. The outcome was functionally and aesthetically satisfactory in all cases and all patients were happy with the outcome. The supraorbital artery island flap is a good alternative for the repair of defects around the orbita in that the color and texture of this flap match up with the orbital region and that it is pliable, simple, safe, and sensorial and requires only a single-session procedure.
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Affiliation(s)
- Hidir Kilinc
- Department of Plastic and Reconstructive Surgery, Inonu University Medical Faculty, Malatya, Turkey.
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Rafii AA, Enepekides DJ. Upper and lower eyelid reconstruction: the year in review. Curr Opin Otolaryngol Head Neck Surg 2006; 14:227-33. [PMID: 16832178 DOI: 10.1097/01.moo.0000233592.76552.d2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Depending on the size, location, and extent of defects, a myriad of surgical approaches may be utilized to repair the eyelids. An understanding of the principles of lid reconstruction as well as orbital and periorbital anatomy is essential when approaching the repair of eyelid defects. While principles of eyelid reconstruction have been established, achieving good functional and aesthetic reconstruction remains challenging. This review examines the methodology of reconstructing eyelid defects, as reported over the last year. RECENT FINDINGS Eyelid reconstruction continues to encompass a wide range of reconstructive options. Reports range from simple modifications of traditional techniques to the use of complex flaps and grafts. SUMMARY While set algorithms have been proposed regarding eyelid reconstruction, the method of choice will ultimately depend on a combination of factors, including availability of tissues, and a surgeon's experience with the available modes of reconstruction.
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Affiliation(s)
- Amir A Rafii
- Department of Otolaryngology, Head and Neck Surgery, University of California, Davis, Sacramento, 95817, USA
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Bibliography. Current world literature. Head and neck reconstruction. Curr Opin Otolaryngol Head Neck Surg 2006; 14:289-91. [PMID: 16832188 DOI: 10.1097/01.moo.0000233602.37541.31] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Loze S, Rousseau P, Cariou G, Darsonval V. [Abbé-Mustardé's flap with lower lid transposition: three clinical cases]. ANN CHIR PLAST ESTH 2006; 52:62-7. [PMID: 16806630 DOI: 10.1016/j.anplas.2006.05.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2005] [Accepted: 05/08/2006] [Indexed: 11/24/2022]
Abstract
The ideal solution first recommended is the use of Abbé-Mustardé's flap with lower lid transposition to rebuild the total loss of the upper eyelid. Every step of the surgical technique has been detailed to improve the result and keep the drawbacks under control. After having read articles on this subject, we describe three clinical cases, which enable us to compare with others surgical techniques that cannot rebuild all the levels of the eyelids and the edge of the eyelashes.
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Affiliation(s)
- S Loze
- Service de chirurgie plastique, reconstructrice et esthétique, CHU d'Angers, 4, rue Larrey, 49033 Angers cedex 01, France.
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