Reconstruction of the eyelids following resection for carcinoma

Full-thickness eyelid defects are created in the resection of eyelid carcinomas. These eyelid colobomas can be satisfactorily reconstructed with remaining eyelid tissue in the majority of cases. Procedures are described for resection of varying portions of the eyelids.     

Reconstruction of full thickness defects of both eyelids

Summary Full thickness defects of the upper eyelids are most often the result of mutilating surgery for cancer. In most cases, immediate reconstruction should be performed in order to insure protection of the cornea.In the past, many techniques have been proposed for the repair of such defects. In this article, the author reviews the most commonly used methods of reconstruction. Using several case examples, he then shows how these techniques can be modified or combined in order to obtain the best functional and cosmetic results even in defects involving the whole of the upper lid and part of the lower eyelid.Paper presented in part at the 3rd Congress of the European Section of the International Confederation for Plastic and Reconstructive Surgery, Den Haag, May 1977     

Eccrine porocarcinoma of the face involving eyelids: a rare case report

Eccrine porocarcinomas (EP) are skin appendage tumors originating from the acrosyringium. Pagetoid form is rare and exceptionally it can involve eyelid. We report a 70-year-old patient presenting a lesion sited on the left cheek region involving the internal canthus, the dorsum of nose and the half inferior eyelid in full thickness. A wide surgical excision was performed and after 2 years of follow up no recurrences have been seen.     

Reconstruction of the lower face and lips.

The first step in rehabilitation of massive lower face injuries is usually control of drooling by the Wilkie operation. When destruction is extensive, the floor of the mouth, chin, upper neck, and mandible should be first restored as a foundation on which the lower lip is independently reconstructed. Local tissue should be used as much as possible. All remnants of normal lip tissue should be conserved and utilized in the reconstruction. When both lips are damaged, upper lip segments are often best used to fill out the lower lip, with total reconstruction of the upper. Although many of the principles of treatment of these injuries are well established, there are still major unsolved problems. These include adequate support of the lower lip, maintenance of the flat shape of the lips, and determination of the end-point of surgery.     

Reconstruction of the face by means of the angle-rotation flap

This article deals with defects in the face. A cervical flap called the angle-rotation flap was created by Schrudde 16 years ago to cover defects such as scarred skin after deep burn injuries as well as skin and subcutaneous defects following removal of dysplastic skin or after accidents. Indications and the method are described.     

肿泡眼患者重睑隆鼻Ⅰ期成形术

目的：探求治疗肿泡眼理想的手术术式和方法。方法：根据肿泡眼患者的局部解剖特点及面部特征，对常规切开法重睑术加以改进，即适当切除上睑皮肤、肥厚眼轮匝肌、眶隔脂肪和眼轮匝肌下脂肪垫，并同期完成隆鼻成形术。结果：应用本方法完成80例，其中75例术后随访3～6个月，美容效果均满意。结论：对肿泡眼患者施行改良切开法重睑术，并同期施行隆鼻成形，可以获得更为满意的美容效果。     

Reconstruction of seventeen full-thickness defects of the eyelids with twenty-two Hübner tarsomarginal grafts.

In 1976, Hübner described a new technique to repair full-thickness defects of the eyelids. In 1993, we decided to adopt this simple and easily reproducible technique that guarantees restoration of the normal aspect of the margin. Subsequently, 17 eyelid reconstructions were performed on 13 patients, requiring the harvesting of 22 tarsomarginal grafts. No cosmetic or functional sequelae in the donor eyelids were observed. One or several functional complications were present in seven out of 17 reconstructed eyelids, including two cases of epiphora, one case of lagophtalmos and two cases of lid notch. Loss of the eyelids was observed in three cases out of six upper eyelid reconstructions and in nine cases out of 11 lower eyelid reconstructions. In all cases, the margin integrity was otherwise preserved. Very few simple techniques achieve that level of quality in the eyelid reconstruction process.     

Reconstruction of the face through cross-face-nerve transplantation in facial paralysis

Summary With definitive and irreparable interruption of the N. facialis a reanimation of the paralysed face can only be brought about through reinnervation of the muscles from the N. facialis of the unparalysed side.Consequently a procedure was worked out, and performed in 5 patients, whereby it is possible, using sural nerve transplants through the face (Cross-Face Nerve-Transplantation, CFNT) to selectively reactivate individual muscle groups. Thus, there are chosen on the healthy side of the face: from the area of distribution of the R. zygomaticus, 3 to 4 fascicles; from the R. buccales, 6 to 8 fascicles: and from the R. marginalis 2 to 3 fascicles. These are separately anastomosed to the fascicles of a number of sural transplants which are passed through the face.For the Orbicularis-oculi function a transplant 15 to 17 cm long is bilaterally positioned through the M. frontalis and upper portion of the Orbicularis oculi. For the mouth-cheek muscles 2 sural nerve transplants, each 13 to 15 cm long, are positioned through the upper lip, and for the lower lip muscles a 6 to 8 cm long transplant is implanted in the chin muscles.The anastomoses of the main facial branches on the paralysed side (R. zygomaticus, R. buccales and R. marginalis) follow after an interval of 4–6 months, at a point just behind their emergence from the parotid gland and distal to the facial artery. Before anastomosis, to assure successful axon budding, a neuroma must be resected from the distal end of the transplant.In addition to full knowledge of the important anatomical considerations necessary for the operation, an exact microsurgical technique is essential for success.Five cases are discussed here with respect to clinical and electrical (EMG) findings. Results after 18, 12, 8, 4 months are reported with consideration of indication, technical procedure, construction of anastomoses, selection of facial nerve fascicles, scheduling of operative phases, results obtained, failures observed.In part presented at the 8th Annual Conference of the Swiss Society for Plastic and Reconstructive Surgery, December 2, 1972 in Zurich.     

Ectropion and entropion of the eyelids

Surgical experience dealing with spastic ectropion or entropion where early eyelid structural changes have set in, has shown that the simpler operative procedures are quite uniformly successful; and that where permanent damage has occurred the plastic operative procedures described give excellent cosmetic and functional results.     

Lymphoedema of the eyelids.

Lymphoedema of the eyelids interfering with vision can be a very debilitating condition. The aetiology is frequently unknown. Successful treatment by debulking and skin grafting has been described in a few cases. We present a case of sudden onset of massive bilateral eyelid oedema, which was treated using staged debulking without skin grafting. However, the cosmetic result was poor in comparison with skin grafting, suggesting that skin grafting may be a better way of treating this difficult problem.