Reconstruction of eyelid defects using the diplene adhesive membrane

Background The abundance of closely packed vital structures in the periocular and palpebral regions makes resection and subsequent reconstructive interventions extremely difficult.Methods In this novel article,we described a method for closing lower eyelid defects after tumor excision using a skin-muscle flap from the upper eyelid along with the use of an adhesive diplene biodegradable membrane.The membrane was used for seamless fixation of the flap and to prevent the development of lower eyelid deformity.Results The case presented herein demonstrated that using diplene adhesive biodegradable membranes has excellent functional and aesthetic results.Conclusion Our findings suggest that an adhesive biodegradable diplene membrane can be used for the reconstruction of the lower eyelid to prevent the occurrence of retraction,for the surgical treatment of ectropion including recurrent cases,and for seamless fixation of flaps to wound surfaces in patients with a tendency to form keloids and hypertrophic scars.

Subcutaneous pedicled propeller flap technique for microscopic reconstruction of eyelid defects

AIM:To describe the subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects and evaluate its outcomes.METHODS:The clinical data of 23 patients(23 eyes)who underwent microscopic reconstruction of eyelid defects with the subcutaneous pedicled propeller flap technique were retrospectively analyzed.All patients underwent eyelid tumor resection and one-stage microscopic reconstruction with the subcutaneous pedicled propeller flap for anterioror posterior-layer eyelid defects.The survival rate of the propeller flap,eyelid function and appearance,tumor recurrence rate,and patient satisfaction were evaluated after the surgery.RESULTS:The patients consisted of 12 men and 11 women,aged 31–82y(mean,58.9y).The longest followup time was 5y,and the shortest was 3mo.All the propeller flaps survived well.There was no significant difference in color and luster between the flap and adjacent tissues,and there was no dog ear phenomenon.No obvious scarring was observed.There were no obvious abnormalities of eyelid morphology or function,and no adverse complications such as exposure keratitis,entropion,ectropion,ptosis,and eyelid retraction.No tumor recurrence was found at the time of the last follow-up.All patients were satisfied with the surgical results.CONCLUSION:The subcutaneous pedicled propeller flap technique for the microscopic reconstruction of eyelid defects has satisfactor y outcomes in terms of eyelid function and esthetics,and merits clinical application.

Conjunctival flap with auricular cartilage grafting: a modified Hughes procedure for large full thickness upper and lower eyelid defect reconstruction

AIM:To investigate the suitability of a modified Hughes procedure,which consists of conjunctival flap with auricular cartilage grafting in reconstructing large full thickness upper and lower eyelid defect.METHODS:Patients with full thickness eyelid carcinoma involving more than 50%margin length who underwent surgical resection were retrospectively reviewed in the study.The defects were reconstructed using conjunctival flap with auricular cartilage grafting,covered with myocutaneous flap above.Followed-up time ranged from 12 to 24 mo.Outcomes were classified as“good”,“fair”,and“poor”by evaluating the margin appearance,eyelid appearance,and complications.RESULTS:A total of 42 patients were enrolled in the study(26 males,16 females,mean age,68.6±7.7 y,range:53 to 82 y).The mean defect widths measured 23.2±2.9 mm(range,17 to 28 mm).The mean posterior lamellar defect height was 5.5±1.3 mm(4 to 8 mm).Thirty-seven patients had a“good”outcome(88.1%),5 patients had a“fair”outcome(11.9%),and no one had a“poor”outcome.CONCLUSION:Conjunctival flap with auricular cartilage grafting and myocutaneous flap grafting is an effective procedure in reconstructing large full thickness upper and lower eyelid defect.It can not only achieve satisfied reconstruction,but also preserve intact tarsal plate of the opposite eyelid,avoiding retraction or entropion.

Extensive full-thickness eyelid reconstruction with rotation flaps through "subcutaneous tunnel" and palatal mucosal grafts

· AIM: To reconstruct the extensive full-thickness defects of eyelids is a challenge for the plastic surgeon because of their complex anatomy and special functions.This article presents and discusses an improved surgical technique in which the orbicularis oculi myocutaneous flap is rotated through a "subcutaneous tunnel" in conjunction with a palatal mucosal graft employed for lining.·METHODS: Data from 22 eyes with extensive full-thickness eyelid defects from various causes between2009 and 2013 were analyzed in this study. After the different layers of eyelid were separated completely, a temporally based orbicularis oculi myocutaneous flap was designed following fishtail lines and was mobilized,leaving the base of the pedicle intact with a submuscular tissue attachment. The flap was then rotated through a "subcutaneous tunnel" to the defect, and the donor site was closed primarily. Posterior lamellar reconstruction was performed with a mucosal graft harvested from the hard palate.·RESULTS: All the flaps were survived without any healing problems. There was no corneal irritation, flap contraction, or significant donor-site morbidity in the follow-up period. The incision scars were almost invisible.The defects were repaired completely, and the evaluations showed satisfactory function and appearance.·CONCLUSION: This technique is an improved singlestage operation and can be applied to repair large, full-thickness eyelid defects from various causes. With our method, the functional and aesthetic results can be obtained in either the upper or lower eyelids.

Reconstruction of total lower eyelid defect-a case series

Background:Total lower eyelid defect after eyelid malignancy excision poses a challenge in the surgical management of total lower eyelid reconstruction.We describe a technique of reconstructing total lower eyelid defect,using a skin flap and the residual lower forniceal conjunctiva.Methods:A retrospective case series review.Five patients had undergone lower eyelid basal cell carcinoma excision.A 3-4 mm margin excision was performed and specimens were sent for paraffin section histological examination.Reconstruction was performed at the same stage,using a skin flap and the residual lower forniceal conjunctiva.A full thickness skin flap is raised from the lateral cheek,with its base at the lateral canthus.Subcutaneous tissues are not included in the skin flap.The lower forniceal conjunctiva is released from the inferior retractors and advanced superiorly to cover the inner surface of the skin flap.The skin flap is transposed to cover the lower eyelid defect and sutured to the soft tissues at the medial end of the defect.The advanced forniceal conjunctiva is sutured to the superior edge of the skin flap forming the new mucocutaneous junction of the eyelid margin.Results:There were 4 females and 1 male,with a mean age of 74 years(range,68-80 years).Histological clearance was achieved in all cases.None of the patients developed lagophthalmos,symblepharon or dry eye symptoms.None of the patients required any further revision surgery.Conclusions:Total lower eyelid defects can be reconstructed using the residual lower fornix conjunctiva and a skin flap.

Revisiting the upper eyelid blepharoplasty advancement flap:adaptation for the repair of full-thickness upper eyelid defects—a case series

A blepharoplasty flap has been previously reported as a useful reconstruction approach for anterior lamellar defects lying between the lash line and the eyelid crease.We herein describe a variation of the blepharoplasty flap and suggest its use as an adjunct in the reconstruction of full-thickness lateral upper eyelid defects.Technique description and retrospective interventional case series.The reconstruction technique was used by an experienced oculoplastics surgeon(ASL)in 3 adults with malignant lesions involving the lateral upper eyelid margin,resulting in a post-excision 50%full-thickness defect between November 2017 and June 2020.The posterior lamella was reconstructed using an ipsilateral free tarsal graft and an inferiorly hinged transposition periosteal flap.The anterior lamella reconstruction was then performed using a local advancement flap utilizing the principles of upper blepharoplasty and Burow’s triangle.Almost full eyelid excursion and full gentle closure were evident at 1–2 weeks follow-up in all three cases.One case later developed 1–2 mm of gentle closure lagophthalmos and was managed successfully with topical lubricants.In all patients,the final eyelid contour and symmetry were adequate,with only minimal scarring,evident already 3 to 4 months postoperative.There were no major complications or need for revisions.The technique described herein highlights the utility of the blepharoplasty flap for lateral,full-thickness upper eyelid defects.This logical variation enables the reconstruction of significant defects using only local tissue,obeying the“like with like”principle,and helps avoid the need for a bridging flap.We provide preliminary evidence of the potential of a good cosmetic outcome of upper lid appearance and contour,together with a fast recovery of appropriate eyelid function.

How and when of eyelid reconstruction using autologous transplantation

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.

Eyelid reconstruction methods:A 10-year review

In ophthalmological practice,eyelid reconstruction is often needed because of the presence of defects that arise after the excision of a tumor or after injuries.Various methods for reconstructing these defects have been previously described.However,it is important to understand the basic principles underlying these techniques and their advantages and disadvantages to ensure the choice of the optimal technique in a particular case.We have analyzed the recent literature on new methods or modifications of existing ones to provide a brief overview of the reconstructive methods of the century for comparison.We searched PubMed and CyberLeninka for articles on restoring eyelid defects reported in the literature over the past 10 years.Most techniques can be considered modified classical reconstruction methods.Postoperative complications included aesthetic defects,such as scarring of the upper or lower eyelid,trichiasis,entropion,and lagophthalmos.Surgeons continue to search for the best methods for complex reconstructive surgery to achieve good cosmetic and aesthetic outcomes.

A tarsus construct of a novel branched polyethylene with good elasticity for eyelid reconstruction in vivo

Branched polyethylene(B-PE)elastomer was investigated for its potential medical application as a tarsus construct.The in vitro results showed that the B-PE and processed B-PE films or scaffolds did not exhibit noticeable cytotoxicity to the NIH3T3 fibroblasts and human vascular endothelial cells(ECs).The B-PE scaffolds with a pore size of 280–480 mm were prepared by using a gelatin porogen-leaching method.The porous scaffolds implanted subcutaneously in rats exhibited mild inflammatory response,collagen deposition and fast fibrovascularization,suggesting their good biocompatibility.Quantitative real-time PCR analysis showed low expression of pro-inflammatory genes and up-regulated expressions of collagen deposition and vascularization-related genes,validating the results of historical evaluation in a molecular level.The B-PE scaffolds and Medpor controls were transplanted in rabbits with eyelid defects.The B-PE scaffolds exhibited a similar elastic modulus and provided desirable repair effects with mild fibrous capsulation,less eyelid deformities,and were well integrated with the fibrovascular tissue compared with the Medpor controls.

Repair of Full-Thickness Defects of the Lower Eyelid

The defect after an enlarged resection of lower eyelid tumor was reconstructed by transplantation of a mucosaCartilage composite graft from the nasal septum and a mucosa graft from the oral cavity for inner part of the eyelid. A pedicled skin flap from the adjacent region was rotated to cover the defect. The results in 4 patients were all satisfactory. The keypoint of the operation is the selection and design of an ideal pedicled skin flap.

Medical and surgical approach to ocular surface reconstruction

Ocular surface disease(OSD)can have a severe impact on patients as it can lead to visual impairment and persistent discomfort.Ocular surface reconstruction(OSR)is an approach to the management of ocular diseases that cause structural damage to the ocular surface.OSR encompasses both medical and surgical treatment options.In this review,we discuss the medical and surgical strategies used in OSR.Medical management often aims to treat tear insufficiency,inflammation,and keratinization.Surgical treatments may be employed for a variety of reasons,including failure of medical management.This may include improving the oculo-palpebral structures in order to improve lid positioning and tear film.Additional therapies focus on improving tear production,such as through salivary gland transplantation.In situations where the ocular surface is so severely damaged that there is loss of limbal stem cells,limbal stem cell transplant(LSCT)may be indicated.Other surgeries such as amniotic membrane transplant(AMT)and conjunctival flaps(CFs)can help promote corneal healing.Finally,in severe situations where the cornea is beyond salvage,corneal transplantation,such as a penetrating keratoplasty(PKP),can be considered.OSR often requires a combination of medical and surgical approaches targeted to each specific patient’s presentation in order to achieve optimal outcomes.

Palpebral Reconstruction in a Secondary Ophthalmology Center in Mali: About a Case

Introduction: Significant trauma to the periocular region can seriously damage ocular structures and their adnexa. The eyelids can be damaged during these traumas. The most frequent lesions are lacerations, the surgical treatment of which is generally simple. In some cases, there are complex traumas where there is a loss of tissue, which is difficult to treat. We report the case of a 26-year-old young man, farmer with no medical and surgical history, referred by the odontostomatology and maxillofacial surgery department for burns to the left hemi face by the exhaust pipe of his motorbike which occurred following a public road accident (AVP). Observation: A 26-year-old young man with no medical-surgical history, visual acuity was 5/10 with good mobility of the globe. In collaboration with the maxillofacial surgeon, a graft of the hemi face was performed using a flap from the inner side of the thigh first. In the second time we carried out a recovery by a flap which consisted in taking a supra-superciliary flap and suturing it at the level of the palpebral edges which, in spite of a fragile vitality of the tissues. Conclusion: The reconstruction of the eyelid is a real problem in our service because of the technical platform and the availability of consumables, which limits us in the choice of the operating technique.

微粒脂肪注射对下睑成形术后就医者泪槽宽度和美观度的影响分析

目的:分析微粒脂肪注射对下睑成形术后就医者泪槽宽度和美观度的影响。方法:选取2022年1月-2022月11月于笔者医院接受治疗的80例泪槽畸形就医者作为研究对象,根据随机数字表法将其分为对照组40例(62眼)与研究组40例(59眼)。对照组就医者接受标准的下睑成形术,研究组就医者在手术期间收集眶下隔脂肪,下睑成形术后经皮微粒脂肪注射入眶下沟。对比两组就医者的术后情况、美观满意度以及术后并发症发生情况。结果:两组就医者的愈合情况以及随访时间比较差异无统计学意义(P>0.05);研究组就医者瞳孔到眼睑的距离、瞳孔到泪沟的距离以及泪槽宽度较对照组改善明显,且泪槽沟畸形等级量表(Tear trough rating scale,TTRS)评分低于对照组(P<0.05);1个月后研究组的美观满意度明显高于对照组(P<0.05);1个月后两组就医者出现血肿、睑外翻、肿胀等并发症的总发生率差异无统计学意义(P>0.05)。结论:在下睑成形术中进行微粒脂肪注射可安全有效地改善泪槽畸形,提高颜面部美观度。

A型肉毒毒素联合眶隔膜张力重建术整复松弛型下睑袋

目的:探讨A型肉毒毒素(Botulinum toxin type A,BTX-A)联合眶隔膜张力重建术整复松弛型下睑袋临床效果。方法:选取2020年12月-2022年12月在笔者医院治疗的松弛型下睑袋就医者为研究对象,共87例。根据治疗方法分为实验组(n=47)和对照组(n=40),实验组行BTX-A联合眶隔膜张力重建术,对照组行眶隔膜张力重建术,术后对就医者进行随访,比较下睑袋术后效果、泪沟畸形(Barton分级)、术后外观满意度、手术并发症。结果:治疗后,实验组瘢痕宽度、VSS低于对照组(P<0.05),手术时间及切口恢复时间与对照组比较,差异无统计学意义(P>0.05);两组就医者Barton分级均有所改善,且实验组0级和1级(95.74%)高于对照组(82.50%)(P<0.05);治疗后,实验组满意度(95.74%)高于对照组(80.00%)(P<0.05);治疗后,实验组与对照组并发症发生率比较,差异无统计学意义(P>0.05)。结论:BTX-A联合眶隔膜张力重建术整复松弛型下睑袋,能够有效消除下睑袋,减少瘢痕增生,改善Barton分级构成,就医者外观满意度较高。

眼睑肿瘤切除后不同眼睑缺损修补方式的疗效比较

目的比较眼睑肿瘤切除后不同眼睑缺损修补方式的修复效果。方法回顾性分析90例眼睑恶性肿瘤患者的临床资料。所有患者行眼睑肿瘤切除术治疗,术后修复眼睑缺损,根据修复方式分为观察组(n=34)和传统组(n=56)。观察组采用异体巩膜移植修补,传统组采用自体唇黏膜和邻近皮瓣转移修补。比较2组患者的修复效果,修复前后眼睑形态及美容效果。比较2组术后1个月的并发症发生情况。结果修复后,观察组总有效率为94.12%,高于传统组的73.21%,差异有统计学意义(P<0.05)。修复后,2组眼睑裂高度、长度差值低于术前,且观察组低于传统组,差异有统计学意义(P<0.05)。修复后,观察组美容效果评分为(1.65±0.27)分,高于传统组的(1.36±0.20)分,差异有统计学意义(P<0.05)。修复后,观察组总并发症发生率为11.76%,低于传统组的30.36%,差异有统计学意义(P<0.05)。结论采用异体巩膜移植修复眼睑缺损的临床效果较佳,可有效改善眼睑形态和美容效果,且并发症发生率低。

Eyelid defect reconstruction

Eyelid reconstruction remains one of the more challenging areas of the face to reconstruct due to its dynamic complexity.They play an essential role in protecting the globe,forming a barrier against trauma,excessive light,and pumping tears towards the nasolacrimal duct system.A critical understanding of the anatomy and soft tissue reconstructive options is essential to properly reconstruct the eyelid and maintain the functional and cosmetic components.

局部皮瓣联合异体巩膜移植修复眼睑及其周围皮肤缺损疗效观察

目的:观察局部皮瓣联合异体巩膜移植修复眼睑及其周围皮肤缺损的临床效果。方法:选取2019年1月-2021年1月笔者医院收治的90例眼睑恶性肿瘤切除术后眼睑及周围皮肤缺损患者,采用随机数字表法分为观察组和对照组,各45例,对照组采用异体巩膜移植修复,观察组在此基础上联合局部皮瓣修复,比较两组修复效果,修复前后睑裂长度、眼睑高度差值以及修复后6个月瘢痕宽度、瘢痕颜色、弹性、平整度、眼睑形态恢复程度、外观满意度评分,以及并发症发生情况。结果:观察组修复总有效率高于对照组(P<0.05);两组修复后睑裂长度、眼睑高度均较修复前降低(P<0.05),且观察组低于对照组(P<0.05);观察组修复后6个月瘢痕宽度小于对照组,瘢痕颜色、弹性、平整度、眼睑形态恢复程度、外观满意度评分均高于对照组(P<0.05);观察组术后上睑下垂、睑缘切痕等并发症总发生率低于对照组(P<0.05)。结论:局部皮瓣联合异体巩膜移植修复眼睑及其周围皮肤缺损疗效显著且并发症少,术后眼睑形态及美学效果良好。

内眦开大术联合改良Park法重睑成形术在双侧单睑伴内眦赘皮患者中的应用效果观察

目的观察内眦开大术联合改良Park法重睑成形术在双侧单睑伴内眦赘皮患者中的应用效果。方法选取82例于2020年9月至2023年9月在贵州医科大学附属乌当医院就诊的有求美需求的双侧单睑伴内眦赘皮患者,均为女性,按照治疗方式不同分为研究组和对照组,各41例(82只眼)。对照组采取内眦开大术联合传统Park重睑成形术,研究组采取内眦开大术联合改良Park法重睑成形术。比较两组患者术中出血量、瘢痕消失时间、术后满意度和临床疗效。结果研究组术中出血量少于对照组,手术时间短于对照组,瘢痕消失时间早于对照组,术后总满意度高于对照组患者,术后7天眼睑宽度小于对照组,眼裂高度大于对照组,术后半年上睑提肌肌力大于对照组,临床疗效总有效率高于对照组,并发症总发生率小于对照组,差异有统计学意义(P均<0.05)。结论内眦开大术联合改良Park法重睑成形术用于治疗双侧单睑伴内眦赘皮临床疗效较好,术中出血量少,术后并发症少,瘢痕消失时间早,恢复速度快,重睑形态对称自然,患者满意度高,值得临床应用。

穿支皮瓣眼睑重建术对眼睑肿瘤术后患者眼睑修复和重建的疗效和安全性

目的探讨穿支皮瓣眼睑重建术对眼睑肿瘤术后患者眼睑修复和重建的疗效和安全性。方法选取2012年1月至2022年12月在我院收治的需行穿支皮瓣眼睑重建术的眼睑肿瘤术后患者80例80眼,均为早、中期眼睑肿瘤,且未发生局部眶内转移和全身转移。采用穿支皮瓣眼睑重建术治疗眼睑缺损。比较患者修复前后睑裂高度和长度差值,美观功能评分,抑郁、焦虑水平;评价患者的临床疗效、不良反应以及预后情况。结果本组80眼中,显效35眼,有效35眼,无效10眼,总有效率为87.5%。修复后患者睑裂高度和长度差值分别为(1.49±0.47)mm和(1.43±0.55)mm,均低于修复前[(2.55±0.35)mm和(2.38±0.49)mm],差异均有统计学意义(均为P<0.01)。修复前患者的美观功能评分为(0.91±0.23)分,修复后患者美观功能评分为(1.87±0.19)分,患者修复后的评分高于修复前,差异有统计学意义(P<0.01)。修复后患者的焦虑自评量表和抑郁自评量表评分分别为(40.14±6.54)分和(39.45±7.65)分,均低于修复前[(59.56±8.23)分和(57.93±8.19)分],差异均有统计学意义(均为P<0.01)。本组80眼患者中,并发症总发生率为27.5%(22/80)。所有患者进行6~36个月的随访,随访时间(12.39±6.17)个月,无肿瘤复发病例。所有复合皮瓣均成活,未发生感染、坏死或移位等。结论穿支皮瓣眼睑重建术对眼睑肿瘤术后患者全层眼睑缺损的修复疗效好且安全。

Soft tissue defects of eyelid and malar region:an experience with the McGregor flap

Aim:Reconstruction of defects of the eyelids and malar region following trauma may result in considerable distortion of the adjacent tissue.A clinical study was undertaken to demonstrate the ability to utilize a modified McGregor flap for reliable soft tissue coverage.Methods:Nine patients with eyelids and malar soft tissue defects were treated over a period of 12 months from July 2013 to June 2014.In this prospective study,a McGregor flap was used for the closure of defects in 9 patients(7 men and 2 women),aged 20-36 years(mean age:27 years).Three sessions of hyperbaric oxygen therapy were administered postoperatively,and patients received subsequent follow-up.Results:Six patients presented with malar and lower eyelid defects,2 patients presented with malar defects,and one patient with upper eyelid,lower eyelid and malar defects following trauma.A McGregor flap was performed in all patients.The preexcision defects varied in size from 3 cm×2 cm to 4 cm×3 cm.No secondary procedures were required in any case.Sutures were removed between 7 and 9 days postoperatively.There were no cases of partial or total flap loss over the course of 10-14 months follow-up.Conclusion:The outcome following use of the McGregor flap procedure was functionally and aesthetically satisfactory in all cases.The McGregor flap is a useful option for the reconstruction of defects following trauma to the upper eyelid,lower eyelid,and malar regions.