1
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Berggren J, Ottosson JN, Albinsson J, Sheikh R, Merdasa A, Tenland K. Forehead flap perfusion monitored by laser speckle contrast imaging: Importance of flap length and thickness. JPRAS Open 2024; 40:222-229. [PMID: 38681530 PMCID: PMC11046244 DOI: 10.1016/j.jpra.2024.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 03/24/2024] [Indexed: 05/01/2024] Open
Abstract
Purpose Forehead flaps are commonly used in oculoplastic surgery to cover defects after tumor excision. Blood perfusion is vital for flap survival. The aim of this study was to monitor the perfusion in forehead flaps and investigate the impact of flap length and thickness. Methods Nineteen forehead flaps in patients undergoing direct brow lift were studied. Perfusion was monitored using laser speckle contrast imaging, immediately after raising flaps consisting of epidermis, dermis, and subcutaneous tissue, and after removing the subcutaneous tissue resulting in a thin flap. Results Perfusion decreased gradually along the length, the mean value being 44% at 5 mm and 26% at 15 mm from the base, in thick flaps. Perfusion was significantly lower in thin flaps, being 13% when measured 15 mm from the flap base (p < 0.0024). Perfusion was better preserved in thick than in thin flaps. Very low perfusion was observed 16.7 mm (16.0-17.3 mm) from the base in thick flaps, and from 10.2 mm (9.8-10.6 mm) from the base in thin flaps (p < 0.0001). Conclusions Flap thickness is important in maintaining adequate blood perfusion and thus increasing the probability of flap survival. This may be particularly important in long flaps and in patients with impaired microcirculation.
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Affiliation(s)
- Johanna Berggren
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Jens Nääv Ottosson
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - John Albinsson
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Aboma Merdasa
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
| | - Kajsa Tenland
- Department of Clinical Sciences, Ophthalmology, Skåne University Hospital, Lund University, Lund, Sweden
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2
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Gur Z, Men C, Ozzello DJ, Liu CY, Kikkawa DO, Korn BS. Reconstruction of Full-Thickness Eyelid Defects Following Tumor Resection: The Bucket Handle Modification. J Craniofac Surg 2024; 35:e325-e329. [PMID: 38385685 DOI: 10.1097/scs.0000000000010006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/27/2023] [Indexed: 02/23/2024] Open
Abstract
PURPOSE To describe a modified approach for full-thickness lower eyelid defect reconstruction. METHODS This is a retrospective review of 5 patients with large full-thickness lower eyelid defects after tumor resection requiring reconstruction. For these lower eyelid defects, a lateral-based or superior-based tarsoconjunctival pedicle flap from the upper eyelid was used to rebuild the posterior lamella. In all cases, the anterior lamella was supplied from an adjacent myocutaneous flap in a bucket handle configuration. Data collection included tumor type and location, size of eyelid defect, presence of canalicular involvement, postoperative eyelid position, patient satisfaction, and complication rates. RESULTS Five eyelids of 5 patients underwent Mohs micrographic excision of basal cell carcinoma followed by reconstruction with a bucket handle flap. Age range was 68 to 96 years old (mean of 81 y). Five patients presented with lower eyelid involvement. The defect size ranged from 80% to 100% of the eyelid. Three patients had canalicular involvement and required bicanalicular nasolacrimal stent placement. After reconstruction, all patients showed good eyelid apposition to the globe with excellent esthetic outcome. No revision procedures were done. Average follow-up time was 13 months (range of 8 to 21 mo). CONCLUSION The bucket handle flap for full-thickness eyelid reconstruction is a simple technique that allows for preservation of all anatomical layers of the anterior lamella. This technique shows promising functional and esthetic outcomes.
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Affiliation(s)
- Zvi Gur
- Department of Ophthalmology, Hadassah Medical Organization and Faculty of Medicine, Hebrew University of Jerusalem, Israel
| | - Clara Men
- Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
| | - Daniel J Ozzello
- Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
| | - Catherine Y Liu
- Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
| | - Don O Kikkawa
- Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
| | - Bobby S Korn
- Viterbi Family Department of Ophthalmology, Division of Oculofacial Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
- Department of Surgery, Division of Plastic and Reconstructive Surgery, UC San Diego, La Jolla, CA
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3
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Nääv Ottosson J, Berggren JV, Tenland K, Bohman E, Sheikh R, Malmsjö M, Merdasa A. The effect of traction force on eyelid blood perfusion during closure of defects. Orbit 2024:1-7. [PMID: 38687914 DOI: 10.1080/01676830.2024.2335999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 03/20/2024] [Indexed: 05/02/2024]
Abstract
PURPOSE In oculoplastic surgery the eyelid tissue is frequently stretched in order to repair defects after tumor surgery. However, there is a paucity of research regarding how stretching affects eyelids. The purpose of this study was to gain insight into how traction force affects eyelid stretch as well as tissue perfusion, using a laser-based in vivo monitoring technique. METHOD Lower-lid pentagonal resections were performed in eight patients and a total of nine eyelids. The medial section of the eyelid was then stretched using a dynamometer up to a force of 2.3 Newtons (N), and eyelid stretching and blood perfusion were continuously measured using laser speckle contrast imaging. RESULTS Tissue perfusion decreased exponentially when eyelid tissue was stretched, with an initial sharp decline followed by a more gradual reduction. Perfusion approached zero at a force of approximately 2.0 N. The length of the eyelid increased with increasing force up to 1.5 N, after which there was only a very slight increase in length. CONCLUSIONS Eyelid tissue seems to respond to traction in a non-linear fashion, where the initial force results in the greatest eyelid stretching and reduction in blood perfusion. The results provide information on the effects of a large force for direct closure of large eyelid defects. Considering how quickly perfusion approaches zero, the high success rate of eyelid reconstruction surgery is likely a testament to the extensive vascularization of the periocular region.
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Affiliation(s)
- Jens Nääv Ottosson
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Johanna V Berggren
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Kajsa Tenland
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Elin Bohman
- Department of Clinical Neuroscience, Division of Eye and Vision, Stockholm, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
| | - Aboma Merdasa
- Department of Clinical Sciences Lund, Lund University, Skåne University Hospital, Lund, Sweden
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Neerukonda VK, Freitag SK, Wolkow N. Histopathologic alterations in the eyelid after Hughes tarsoconjunctival flap: loss of Meibomian glands with preservation of accessory lacrimal glands. Orbit 2024; 43:115-118. [PMID: 35619561 DOI: 10.1080/01676830.2022.2080232] [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] [Received: 12/22/2021] [Accepted: 05/02/2022] [Indexed: 10/18/2022]
Abstract
A 71-year-old female with invasive squamous cell carcinoma of the lower eyelid involving the ocular surface underwent surgical excision with negative margins and a subsequent reconstruction. The posterior lamellar defect was reconstructed with a Hughes tarsoconjunctival flap, and the anterior lamellar defect was reconstructed by advancing the lower eyelid skin. Three years later, the patient presented with signs suspicious for recurrence involving the tarsoconjunctival graft: a nodule along the mucocutaneus junction, symblepharon, and forniceal shortening. Repeat scouting biopsies showed variable degrees of moderate to severe squamous dysplasia so the patient underwent a staged full thickness excision of the lower eyelid and involved conjunctiva followed by reconstruction. Direct immunofluorescence was not diagnostic for ocular cicatrcial pemphigoid. Permanent histopathologic sections did not show any carcinoma, but the full thickness excisions involving the prior Hughes tarsoconjunctival flap highlighted two notable alterations: the Meibomian glands were absent and the accessory lacrimal glands of Wolfring were transposed to the mucocutaneous junction of the reconstructed lower eyelid.
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Affiliation(s)
- Vamsee K Neerukonda
- Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical SchoolDavid G. , Boston, Massachusetts, USA
| | - Suzanne K Freitag
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
| | - Natalie Wolkow
- Cogan Laboratory of Ophthalmic Pathology, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical SchoolDavid G. , Boston, Massachusetts, USA
- Ophthalmic Plastic Surgery Service, Department of Ophthalmology Massachusetts Eye and Ear, Harvard Medical School, Boston, Massachusetts, USA
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5
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Berggren JV, Stridh M, Malmsjö M. Perfusion Monitoring During Oculoplastic Reconstructive Surgery: A Comprehensive Review. Ophthalmic Plast Reconstr Surg 2022; 38:522-534. [PMID: 34919068 DOI: 10.1097/iop.0000000000002114] [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
PURPOSE Knowledge of how blood perfusion is affected during and after reconstructive surgery is of great importance to predict the survival of grafts and flaps. When commonly used reconstructive procedures were developed a century ago, they were based on empirical observations of clinical outcome. METHODS This is a comprehensive literature review that summarizes the current state of knowledge regarding microvascular perfusion monitoring during oculoplastic procedures. RESULTS Over the years, a number of techniques for perfusion monitoring have been developed as an attempt to be more objective than clinical examination using traditional methods such as observations of skin temperature, turgor, color, smell, and capillary refill time. There are limited publications regarding microvascular perfusion monitoring during reconstructive procedures in the periocular area. Modern laser-based techniques have been attractive due to their noninvasive nature. CONCLUSIONS Today, modern, noninvasive techniques are available to monitor perfusion during and after surgery. This has increased our knowledge on the perfusion in common oculoplastic surgery procedures. A detailed understanding of how blood perfusion is affected will hopefully allow the improvement of surgical techniques for better clinical outcome.
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Affiliation(s)
- Johanna V Berggren
- Department of Clinical Sciences Lund, Skåne University Hospital, Lund University, Ophthalmology, Lund, Sweden
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Wiktorin AHC, Berggren JV, Malmsjö M, Lindstedt S, Sheikh R, Bohman E. Mapping of Perfusion During Full-Thickness Blepharotomy Using Laser Speckle Contrast Imaging. Ophthalmic Plast Reconstr Surg 2022; 38:588-592. [PMID: 35657677 DOI: 10.1097/iop.0000000000002218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The aim of this study was to monitor how the blood perfusion in human upper eyelids is affected during full-thickness blepharotomy. METHODS Seven eyelids in 5 patients with upper eyelid retraction due to Graves' disease underwent full-thickness blepharotomy. Perfusion was measured using laser speckle contrast imaging in the eyelid margin and in the conjunctival pedicle. RESULTS Immediately following the procedure, a nonsignificant reduction in perfusion was observed in the skin of the pretarsal eyelid margin, being 66% of the initial value ( p = n.s.). However, a statistically significant decrease in perfusion, to 53% of the initial value ( p < 0.01), was seen in the central pedicle of the conjunctiva. There were no surgical complications such as infection, signs of ischemia, or bleeding. CONCLUSIONS In this study, eyelid perfusion was mapped during full-thickness blepharotomy for the first time using laser speckle contrast imaging. The results showed that perfusion is sufficiently preserved during surgery, probably due to the rich vascular supply in the periocular region, which may explain the low risk of postoperative complications such as ischemia and infection.
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Affiliation(s)
- Anna H C Wiktorin
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden
| | - Johanna V Berggren
- Department of Clinical Sciences, Ophthalmology and Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Malin Malmsjö
- Department of Clinical Sciences, Ophthalmology and Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Clinical Sciences, Ophthalmology and Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences, Ophthalmology and Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Elin Bohman
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden
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Miotti G, Zeppieri M, Rodda A, Salati C, Parodi PC. How and when of eyelid reconstruction using autologous transplantation. World J Transplant 2022. [DOI: doi.org/10.5500/wjt.v12.i7.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Miotti G, Zeppieri M, Rodda A, Salati C, Parodi PC. How and when of eyelid reconstruction using autologous transplantation. World J Transplant 2022; 12:175-183. [PMID: 36051449 PMCID: PMC9331409 DOI: 10.5500/wjt.v12.i7.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Reconstructive surgery of the eyelid after tumor excision, trauma or other causes can be challenging, especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes. The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction. Surgical procedures are various, based on the use of both flaps, pedicled or free, and grafts, in order to guarantee adequate tissue reconstruction and blood supply, which are necessary for correct healing. Common techniques normally include the use of local tissues, combining non-vascularized grafts with a vascularized flap for the two lamellae repair, to attempt a reconstruction similar to the original anatomy. When defects are too wide, vast, deep, and complex or when no adjacent healthy tissues are available, distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction. With regards to the anterior lamella, full thickness skin grafts are commonly preferred. With regards to the reconstruction of posterior lamella, there are different graft options, which include conjunctival or tarsoconjunctival, mucosal or palatal or cartilaginous grafts usually combined with local flaps. Free flap transplantation, normally reserved for rare select cases, include the use of the radial forearm and anterolateral flaps combined with mucosal grafts, which are surgical options currently reported in the literature.
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Affiliation(s)
- Giovanni Miotti
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Agostino Rodda
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
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The Köllner Tarsoconjunctival Flap for Lower Eyelid Reconstruction: Historical Perspective and Surgical Outcomes of 140 Cases. Ophthalmic Plast Reconstr Surg 2021; 38:294-299. [PMID: 34812184 DOI: 10.1097/iop.0000000000002099] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE While Wendell Hughes popularized the tarsoconjunctival flap for lower eyelid reconstruction, most modern procedures are derived from the technique described by Köllner in 1911. This study reviews the history, techniques, and outcomes of a large series of patients treated with a modified Köllner flap. METHODS In this observational cohort study, medical records and photographs were reviewed in patients undergoing surgery between 2005 and 2020. Patient demographics, complications, secondary interventions, and outcomes were evaluated. RESULTS Marginal defect size ranged from 12 to 41 mm among the 140 study patients. Ancillary procedures included lower eyelid conjunctival flaps (n = 64) and septal orbicularis flaps (n = 68). The anterior lamella was reconstructed with skin grafts (n = 86), flaps (n = 10), or combined flaps/grafts (n = 44). Pedicle division was performed 23 to 84 days after primary repair. Subsequent interventions included steroid injection (n = 10), cryotherapy (n = 10), marginal erythema treatment (n = 9), and upper eyelid retraction repair (n = 6). Tearing (6.5%) and dryness (10%) were the most common postoperative symptoms, with most patients (78.6%) being asymptomatic. A good-excellent functional outcome was achieved in 94.3% and cosmetic outcome in 85.0% of cases. Defects <30 mm in width (P = 0.0001), defects not involving a canthus (P = 0.0158), and upper eyelid skin graft donor sites (P = 0.0001) were associated with better outcomes. CONCLUSIONS The Köllner tarsoconjunctival flap is an effective technique to repair moderate-large lower eyelid defects, with the majority of patients achieving good-excellent cosmetic and functional outcomes. Factors associated with a poorer result include marginal eyelid defects ≥30 mm in width, defects involving a canthus, and non-upper eyelid skin graft donor sites. Most patients are asymptomatic after surgery.
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Berggren J, Castelo N, Tenland K, Dahlstrand U, Engelsberg K, Lindstedt S, Sheikh R, Malmsjö M. Reperfusion of Free Full-Thickness Skin Grafts in Periocular Reconstructive Surgery Monitored Using Laser Speckle Contrast Imaging. Ophthalmic Plast Reconstr Surg 2021; 37:324-328. [PMID: 32991497 PMCID: PMC8939628 DOI: 10.1097/iop.0000000000001851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/27/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Free skin grafts are frequently used in reconstructive surgery. However, little is known about the course of reperfusion due to the previous lack of reliable perfusion monitoring techniques. The aim of this study was to use state-of-the-art laser speckle contrast imaging to monitor free skin grafts in the periocular area. METHODS Seven patients needing surgery due to tumor removal or cicatricial ectropion in the periocular region underwent reconstructive surgery using free skin grafts from either the contralateral upper eyelid or the upper inner arm. The free skin grafts measured 10-30 mm horizontally and 9-30 mm vertically. Blood perfusion was monitored using laser speckle contrast imaging immediately postoperatively (0 weeks) and at follow-up after 1, 3, and 7 weeks. RESULTS All grafts were reperfused gradually during healing, the median value being 46% in the central part of the graft after 1 week and 79% after 3 weeks. The grafts were completely reperfused after 7 weeks. No difference was observed in the rate of reperfusion between the center and periphery of the grafts (p = not significant). The cosmetic and functional outcome was excellent in all but 1 patient, who developed ectropion that had to be surgically corrected. CONCLUSIONS Skin grafts in the periorbital area are fully reperfused after 7 weeks. The periocular area is known to be well-vascularized and thus forgiving to reconstructive surgery. Future investigations of the reperfusion of free skin grafts in other parts of the body or in higher-risk populations should be carried out.
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Affiliation(s)
- Johanna Berggren
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
| | - Nazia Castelo
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
| | - Kajsa Tenland
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
| | - Ulf Dahlstrand
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
| | - Karl Engelsberg
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Sandra Lindstedt
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Rafi Sheikh
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
| | - Malin Malmsjö
- Department of Clinical Sciences, Skåne University Hospital, Lund University
- Department of Ophthalmology, Skåne University Hospital, Lund University
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Berggren JV, Tenland K, Memarzadeh K, Sheikh R, Hult J, Lindstedt S, Malmsjö M. The Effect of Canthotomy on Blood Perfusion During the Repair of Lower Eyelid Defects. Ophthalmic Plast Reconstr Surg 2021; 36:135-138. [PMID: 31743283 DOI: 10.1097/iop.0000000000001489] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE Canthotomy is frequently used to mobilize extra tissue when repairing larger lower eyelid defects. The aim of this study was to explore the effect of canthotomy on blood perfusion and oxygen tension. METHODS Eight pigs underwent a wedge resection of the lower eyelid and canthotomy (with cantholysis involving the lateral palpebral artery). The wedge resection was performed 8, 6, and 4 mm from the canthotomy. Perfusion and oxygen tension were monitored in the eyelid between the wedge resection and canthotomy using laser Doppler velocimetry and a Clark electrode. Verapamil was administered, and measurements were also performed 12 hours after surgery, to investigate the possible effects of vasospasm RESULTS:: The wedge resection alone did not affect perfusion. Canthotomy led to a reduction in perfusion; being 60% when the length of remaining eyelid was 8 mm, 32% when it was 6 mm, and 24% when it was 4 mm. Similar results were observed for oxygen tension. Vasospasm did not affect the results. CONCLUSIONS Canthotomy in combination with a wedge resection of the lower eyelid affects blood perfusion. A smaller length of remaining eyelid tissue will have less perfusion. This may not have any implications in cases of direct closure, but may play a role when the eyelid is to provide oxygen and nutrients to avascular grafts.
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Affiliation(s)
| | | | | | - Rafi Sheikh
- Department of Clinical Sciences Lund, Ophthalmology
| | - Jenny Hult
- Department of Clinical Sciences Lund, Ophthalmology
| | - Sandra Lindstedt
- Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund University, Skåne University Hospital, Lund, Sweden
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12
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Tenland K, Berggren J, Engelsberg K, Bohman E, Dahlstrand U, Castelo N, Lindstedt S, Sheikh R, Malmsjö M. Successful Free Bilamellar Eyelid Grafts for the Repair of Upper and Lower Eyelid Defects in Patients and Laser Speckle Contrast Imaging of Revascularization. Ophthalmic Plast Reconstr Surg 2021; 37:168-172. [PMID: 32467523 PMCID: PMC10552809 DOI: 10.1097/iop.0000000000001724] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE It is generally believed that large eyelid defects must be repaired using a vascularized flap for 1 lamella, while the other can be a free graft. Recent studies indicate that the pedicle of a tarsoconjunctival flap does not contribute to blood perfusion. The purpose of this study was to explore whether large eyelid defects can be repaired using a free bilamellar eyelid autograft alone. METHODS Ten large upper and lower eyelid defects resulting from tumor excision were reconstructed using bilamellar grafts harvested from the contralateral or opposing eyelid. Revascularization of the flap was monitored during healing using laser speckle contrast imaging, and the surgical outcome was assessed. RESULTS The functional and cosmetic results were excellent. All grafts survived and there was no tissue necrosis. Only 1 patient underwent revision after 4 days as the sutures came loose. Two patients developed minimal ectropion but needed no reoperation. All patients were satisfied with the surgical results. Perfusion monitoring showed that the grafts were gradually revascularized, exhibiting 50% perfusion after 4 weeks and 90% perfusion after 8 weeks. CONCLUSIONS A free bilamellar eyelid graft appears to be an excellent alternative to the tarsoconjunctival flap procedure in the reconstruction of both upper and lower eyelid defects, especially in patients who cannot tolerate visual axis occlusion or the 2-stage procedure of the conventional staged flap procedure.
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Affiliation(s)
- Kajsa Tenland
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Johanna Berggren
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Karl Engelsberg
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Elin Bohman
- Division of Ophthalmology and Vision, Department of Clinical Neuroscience, Karolinska Institutet, St. Erik Eye Hospital, Stockholm, Sweden
| | - Ulf Dahlstrand
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Nazia Castelo
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Sandra Lindstedt
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Cardiothoracic Surgery, Lund, Sweden
| | - Rafi Sheikh
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
| | - Malin Malmsjö
- Lund University, Skåne University Hospital, Department of Clinical Sciences Lund, Ophthalmology, Lund, Sweden
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An L, Sun W, Wu L, Feng Y, Shao J, Zhang S, Wang Y, Yu D. Design of a reliable surgery process for large back defects: Jigsaw puzzle flap concept based on free-style perforator. Asian J Surg 2020; 43:932-934. [DOI: 10.1016/j.asjsur.2020.02.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Accepted: 02/07/2020] [Indexed: 10/24/2022] Open
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Re: "The Effect of Canthotomy on Blood Perfusion During the Repair of Lower Eyelid Defects". Ophthalmic Plast Reconstr Surg 2020; 36:423. [PMID: 32658140 DOI: 10.1097/iop.0000000000001702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Repair of a Full-thickness Eyelid Defect With a Bilamellar Full-thickness Autograft in a Porcine Model (Sus scrofa). Ophthalmic Plast Reconstr Surg 2019; 36:395-398. [PMID: 31868788 DOI: 10.1097/iop.0000000000001569] [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]
Abstract
PURPOSE It has been demonstrated the pedicle of a tarsoconjunctival flap advancement does not appear to supply the flap itself and the vascularization of the remaining eyelid/tear film is thought to offer adequate nourishment for survival of the flap; as such, a swine model was constructed to assess the viability of a bilamellar autograft for repair of large full-thickness eyelid defects. METHODS Full-thickness defects of varying sizes were created in each lower eyelid of 4 Yorkshire/Yorkshire crossed swine. The defects were then closed with a full-thickness ipsilateral graft from the upper eyelid. Large full-thickness defects were then created in the upper and lower eyelids of 8 Yorkshire/Yorkshire crossed swine and closed with bilamellar autografts from the contralateral eyelids. The subjects were then monitored postoperatively and assessed clinically for graft viability at postoperative days 1, 7, and 30. At the conclusion of the 30-day postoperative monitoring period, necropsy was performed and histopathologic analysis utilized to assess cell morphology and vessel ingrowth of the graft sites. RESULTS In total, 28 full-thickness bilamellar grafts were constructed and examined. At the conclusion of the postoperative monitoring period, 27 of the grafts were deemed clinically viable and vascular ingrowth was determined to be equivalent to unaffected eyelid sections by histopathologic analysis. One case of postoperative hematoma was noted in the failed graft. One case of postoperative wound dehiscence required subsequent surgical repair. No clinically significant notching of the graft sites was noted. No cases of wound infection, corneal decompensation, or forniceal shortening were identified. CONCLUSIONS This analysis demonstrates the viability of a full-thickness bilamellar autograft as a surgical alternative in the repair of large full-thickness eyelid defects in a porcine model. The postoperative outcomes are consistent with the recent literature. Additional studies need to be performed to assess the procedure's clinical utility in human subjects before incorporation into clinical practice.
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