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Mozo Cuadrado M, de Oliveira A, Procianoy F. Limited vertical tarsal resection in a case of basal cell carcinoma of the lower eyelid. ARCHIVOS DE LA SOCIEDAD ESPANOLA DE OFTALMOLOGIA 2023; 98:540-543. [PMID: 37353072 DOI: 10.1016/j.oftale.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 05/15/2023] [Indexed: 06/25/2023]
Abstract
We present the clinical case of a 71-year-old woman with a history of multiple basal cell carcinomas (BCC) who presented a nodular lesion in practically the entire extension of the free edge of the lower eyelid. The lesion was approached by excision of the palpebral margin with limited vertical resection of the tarsus and Tripier flap with a correct aesthetic and functional result, free histological margins and no recurrence in a 12-month follow-up.
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Affiliation(s)
- M Mozo Cuadrado
- F.E.A. Oftalmología. Hospital Universitario de Navarra, Spain.
| | - A de Oliveira
- Fellow de Oculoplástica do Serviço de Oftalmologia do Hospital de Clínicas de Porto Alegre (HCPA), Brazil
| | - F Procianoy
- Chefe do Setor de Oculoplástica do Serviço de Oftalmologia do Hospital de Clínicas de Porto Alegre (HCPA)/Universidade Federal do Rio Grande do Sul, Brazil
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Yan Y, Ji Q, Fu R, Liu C, Yang J, Yin X, Li Q, Huang R. Biomaterials and tissue engineering strategies for posterior lamellar eyelid reconstruction: Replacement or regeneration? Bioeng Transl Med 2023. [DOI: 10.1002/btm2.10497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Affiliation(s)
- Yuxin Yan
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Qiumei Ji
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Rao Fu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Chuanqi Liu
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Jing Yang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Xiya Yin
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
- Department of Plastic and Burn Surgery West China Hospital, Sichuan University Chengdu China
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
| | - Ru‐Lin Huang
- Department of Plastic and Reconstructive Surgery Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine Shanghai China
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Yan Y, Fu R, Ji Q, Liu C, Yang J, Yin X, Oranges CM, Li Q, Huang RL. Surgical Strategies for Eyelid Defect Reconstruction: A Review on Principles and Techniques. Ophthalmol Ther 2022; 11:1383-1408. [PMID: 35690707 PMCID: PMC9253217 DOI: 10.1007/s40123-022-00533-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 05/23/2022] [Indexed: 02/08/2023] Open
Abstract
Reconstruction of eyelid defects, especially the posterior lamella, remains challenging because of its anatomical complexity, functional considerations, and aesthetic concerns. The goals of eyelid reconstruction include restoring eyelid structure and function and achieving an aesthetically acceptable appearance. An in-depth understanding of the complex eyelid anatomy and several reconstructive principles are mandatory to achieve these goals. Currently, there are multiple surgical treatment options for eyelid reconstruction, including different flaps, grafts, and combinations of them. This comprehensive review outlines the principles of reconstruction and discusses the indications, advantages, and disadvantages of currently available surgical techniques. We also propose our clinical thinking for solving specific clinical questions in eyelid reconstruction and offer perspectives on new potential methodologies in the future.
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Affiliation(s)
- Yuxin Yan
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Rao Fu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Qiumei Ji
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Chuanqi Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Jing Yang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China
| | - Xiya Yin
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.,Department of Plastic and Burn Surgery, West China Hospital, Sichuan University, Chengdu, China
| | - Carlo M Oranges
- Department of Plastic, Reconstructive, and Aesthetic Surgery, Geneva University Hospitals, Geneva, Switzerland
| | - Qingfeng Li
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
| | - Ru-Lin Huang
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, 639 Zhizaoju Road, Shanghai, 200011, China.
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Akduman B, Kara M, Koçer U. An effective technique in lower eyelid reconstruction in elderly patients: analysis of postoperative results of the Tripier flap technique. EUROPEAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.1007/s00238-022-01983-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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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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Lemaître S, Lévy-Gabriel C, Desjardins L, González-Candial M, Gardrat S, Dendale R, Cassoux N, Couturaud B. Outcomes after surgical resection of lower eyelid tumors and reconstruction using a nasal chondromucosal graft and an upper eyelid myocutaneous flap. J Fr Ophtalmol 2018; 41:412-420. [PMID: 29778279 DOI: 10.1016/j.jfo.2017.10.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 10/10/2017] [Accepted: 10/20/2017] [Indexed: 01/04/2023]
Abstract
INTRODUCTION Surgical excision of large malignant lower eyelid tumors may cause important full-thickness eyelid defects. The reconstruction of such defects must restore the physiologic function of the eyelid and also re-establish an acceptable aesthetic result. MATERIALS AND METHODS We report the outcomes of full-thickness excision of tumors extending over half of the horizontal lid length, followed by reconstruction using a nasal chondromucosal graft (coming from the ipsilateral ala of the nose) and an upper eyelid myocutaneous flap. Histological analysis of the specimen identified the tumor type and surgical margins for each patient. RESULTS A total of 25 patients were operated using this reconstruction technique between March 2009 and June 2015: 17 basal cell carcinomas, 3 spindle cell carcinomas and 5 conjunctival melanomas (out of which 2 were associated with lentigo maligna). Mean duration of follow-up after surgery was respectively 36, 41 and 17 months for each of these 3 tumor types. We found a single local tumor recurrence and this was a basal cell carcinoma in a xeroderma pigmentosum patient. After surgery, none of the patients had lagophthalmos or ocular surface complications. Only 4 patients had a 1mm scleral show postoperatively; 3 other patients developed a small retraction of the eyelid after adjuvant radiotherapy and a 1mm scleral show occurred. CONCLUSION In malignant tumors, complete surgical excision with histological margins adapted to tumor type prevents local recurrence in most cases. Our repair strategy of nasal chondromucosal graft and skin-muscle flap for large inferior eyelid defects provides good functional and aesthetic results.
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Affiliation(s)
- S Lemaître
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France; Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França, 17007 Girona, Spain.
| | - C Lévy-Gabriel
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - L Desjardins
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - M González-Candial
- Hospital Universitari de Girona Doctor Josep Trueta, Avinguda de França, 17007 Girona, Spain
| | - S Gardrat
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
| | - R Dendale
- Centre de protonthérapie, Institut Curie, campus universitaire d'Orsay, bâtiment 101, 91400 Orsay, France
| | - N Cassoux
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France; Université Paris-Descartes, 12, rue de l'École-de-Médecine, 75270 Paris cedex 06, France
| | - B Couturaud
- Institut Curie, 26, rue d'Ulm, 75248 Paris cedex 05, France
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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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Superpulsed CO 2 Laser with Intraoperative Pathologic Assessment for Treatment of Periorbital Basal Cell Carcinoma Involving Eyelash Line. Dermatol Res Pract 2014; 2014:931657. [PMID: 25371667 PMCID: PMC4211181 DOI: 10.1155/2014/931657] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2014] [Revised: 09/14/2014] [Accepted: 09/16/2014] [Indexed: 11/18/2022] Open
Abstract
Background. Periorbital basal cell carcinoma (BCC) is considered a high risk case because it is associated with high rate of recurrence and complication. Superpulsed CO2 laser with intraoperative pathologic assessment could be an alternative and appropriate treatment for periocular lesions where Mohs micrographic surgery is not available. Objective. To evaluate the efficacy of superpulsed CO2 laser therapy with intraoperative pathologic assessment on periocular BCC involving eyelash line. Method. This follow-up study was performed on 20 patients with a total of 21 BCC lesions that were pathologically documented. Firstly, debulkation of tumoral mass was done by curettage. Then, irradiation and intraoperative pathologic evaluation were done by concurrent CO2 laser. The patients were followed up for a period of 36 months. Results. Out of 21 lesions, the nodular type accounted for 15 (71.4%) lesions, and 12 (57.1%) lesions were seen in the lower lid as the most common clinical type and site involvement. Twenty BCC lesions (95.2%) were treated after one session. Damage to eyelash was seen in 2 (10%) patients, but ectropion and other complications were not seen in any patient. Conclusion. Treatment with superpulsed CO2 laser and intraoperative pathologic evaluation for periorbital BCC lesions much close to conjunctiva could be an effective method with minimal complications without major danger of recurrence. This modality can be used with care in the inner canthus and high risk pathologic lesions.
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