Upper eyelid reconstruction: a short report of an eyelid defect following a thermal burn

While the principles of eyelid reconstruction are well-established, achieving good functional and aesthetic reconstruction remains challenging. This communication presents a technique that we used on a young patient with an eyelid defect following a thermal burn. The patient was operated on to reconstruct the entire upper eyelid using, as a posterior lamella, a mucochondrial autologous graft taken from the ala of the nose as a tarsus and conjunctiva substitutes that were sutured to the Elevator palpebrae superioris aponeurosis and muscle. On the other hand, to reconstruct the anterior lamella, which consists of skin and muscle, the surgeons used a myocutaneous temporal flap taken from the region immediately lateral to the external canthus of the palpebral region, and which, after being isolated following a drawing of the upper eyelid to be reconstructed, was rotated and then sutured to the posterior lamella using the orbicularis oculi muscle as a pedicle.     

Upper eyelid defect by dog bite reconstructed by an ipsilateral advanced tarsoconjunctival flap with skin graft

A technique for reconstruction of a traumatic upper-eyelid marginal defect utilizing a local tarsoconjunctival advancement flap with a skin graft is presented. A 22-year-old woman was bitten by a dog, resulting in a full-thickness loss of approximately the central half of her left upper eyelid. Debridement was performed under topical anaesthesia followed by one-stage upper eyelid reconstruction. The residual tarsal plate was used as a tarsoconjunctival advancement flap to reconstruct the posterior lamella of the defect. Skin from the posterior aspect of the left ear was grafted onto the reconstructed posterior lamella with two setting tarsorrhaphy sutures. One month postoperatively, the patient had an excellent cosmetic result with appropriate upper eyelid height and curvature, although cilia were not transplanted. The technique described offers a one-stage procedure with a simple surgical method providing on appropriate cosmetic and functional result.     

Fricke supraorbital flap for reconstruction of total lower eyelid defects

Summary Split or full thickness eyelid defects resulting from tumor destruction or surgical excision present a dilemma for plastic and reconstructive surgeons. Full thickness eyelid replacement requires composite grafting of the skin, together with tarsal support of its substitute and mucosa. The flap described by Fricke in 1829 was used for reconstruction of anterior lamella in six lower eyelid defects. In three of our cases chondromucosal grafts taken from nasal septum were utilized for posterior lamella repair. The results have been satisfactory from a functional and cosmetic standpoint.     

利用耳廓复合组织片移植治疗环缩耳畸形

目的　用简单有效的方法治疗先天性单侧环缩耳畸形。方法　利用正常侧耳廓复合组织片移植于对侧畸形的环缩耳 (Ⅱ型 12例 ,Ⅰ型 3例 ) ,以此延长耳轮、显露耳舟及三角窝 ,从而矫正畸形。结果　 15例患者的耳廓复合组织片全部成活 ,耳轮延长 ,耳舟显露 ,从而使双耳基本对称。结论　本手术矫正环缩耳简单易行 ,效果满意。     

Aesthetic and functional management of eyelid and orbital reconstruction

Major head and neck resections may result in ocular defects that are functionally and/or aesthetically incapacitating. Restoration of the eyelid and orbit must address lateral canthal laxity, midface ptosis, eyelid retraction and ptosis, globe malposition, and dysfunctional lacrimal drainage. Here we discuss lateral canthal reconstruction, midface-lifting, eyelid spacer grafts, gold weight placement, surgical approaches to the orbit, free flap options for orbital reconstruction, and endoscopic lacrimal surgery. Successful outcomes in eyelid and orbital reconstruction depend upon proper knowledge, planning, and multidisciplinary management.     

The conchal cartilage graft in nasal reconstruction.

Graft selection remains a problem in nasal reconstruction, where the use of autologous cartilage still provides the best resistance to infection and a low degree of resorption. As the nasal septum is often absent or insufficient in such patients, the auricular concha offers a valid alternative. A group of 53 patients suffering from developmental iatrogenic and post-traumatic nasal pathologies were treated surgically by means of conchal grafts. Detailed examination of the anatomical defects presented by the patients made it possible to plan the removal of grafts from the area of the auricular concha with great precision. Guidelines were developed for the areas of the cymba concha and cavum concha to be used as sources for some types of commonly used graft. The technique described made it possible to restore the anatomically deficient structures with satisfactory aesthetic and reconstructive results. The use of cartilage grafts also addressed functional breathing problems. The auricular concha is easy to shape and can provide grafts to reconstruct the various anatomical components of the nasal pyramid. To this end, it proves very useful to save as much cartilage as possible and to pinpoint affinities between some areas of the concha and the structures to be reconstructed.     

Eyelid reconstruction using a hard palate mucoperiosteal graft combined with a V-Y subcutaneously pedicled flap.

Full-thickness eyelid defects after tumour ablation require the reconstruction of two layers, the anterior and posterior lamellae. Eyelids were successfully reconstructed after removal of malignant tumours in four patients using a hard palate mucoperiosteal graft combined with a curved V-Y subcutaneously pedicled flap. Although there have been some reports of hard palate mucosal grafts for reconstruction of the posterior lamella, the graft is not sufficiently rigid to support the reconstructed eyelid without the aid of supporting materials such as cartilage grafts. The hard palate mucoperiosteal graft seems to be rigid enough to support the reconstructed eyelid without the use of cartilage or other supporting materials. The subcutaneously pedicled V-Y advancement flap is useful for reconstruction of the anterior lamella in partial eyelid defects. We used it with a modified curved design to allow easy advancement and to make postoperative scars inconspicuous.     

Auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap

A technique to take an auricular composite graft from the scapha and its repair using a retroauricular subcutaneous pedicle flap is described. Not only can this procedure remove the composite graft without auricular deformity, but it is also useful for covering small auricular defects after trauma or tumor excision.     

Forehead flap periorbital reconstruction

OBJECTIVE: To evaluate functional and aesthetic results of periorbital defect repair using forehead flaps. DESIGN: Retrospective review of patients who received periorbital defect repair by 3 of us with a paramedian forehead flap alone or in conjunction with other local or regional flaps, bone grafts, or cartilage grafts. Flap survival, functional results, and postoperative complications were determined by physical examination at regular follow-up. Three experienced surgeons other than us quantified aesthetic outcomes using a 10-cm visual analog scale. RESULTS: Eighteen patients underwent periorbital defect repair between August 1, 1989, and December 31, 2000. Defects ranged from 8 to 300 cm(2) (mean, 46.8 cm(2)) in area. The most commonly involved primary structures were the medial canthus, lacrimal drainage system, and medial upper eyelid. The mean improvement on a 10-cm visual analog scale was 1.6 from before resection to after reconstruction and 3.8 from tumor resection to after reconstruction. In all relevant cases, globe coverage and lacrimal drainage system patency were excellent. No patients experienced fistula formation or eyelid retraction. CONCLUSION: The reliability, versatility, and relative technical simplicity of the forehead flap provide excellent cosmetic and functional results in reconstruction of intermediate-sized periorbital defects, especially those associated with nasal defects.     

Lower eyelid reconstruction by multiple subcutaneous pedicle flaps: a new method.

In this paper we present an original technique for the reconstruction of the full thickness of the lower eyelid after excision of neoplasms. The method is based on the mobilisation of multiple pedicle subcutaneous flaps outlined in the same eyelid and supported by a chondro-mucosal graft. This technique is used for central and off-central losses which involve the outer rim or up to 75% of the width of the whole eyelid. This method is an alternative to the Hughes (1945), Mustardé (1981), Tenzel and Stewart (1978) and McGregor (1973) techniques which we have previously used for this type of reconstruction. The follow-up is satisfactory in terms of the oncological, functional and aesthetic aspects, which represent an inseparable triad in reconstructive eyelid surgery.     

Histology of partial thickness double composite eyelid graft

Double composite grafting is a technique used in the repair of large (greater than 75%) eyelid defects due to tumor resection, trauma, or congenital coloboma. The procedure utilizes two partial thickness composite grafts derived from two unaffected lids. The skin defect is covered by a pedicle skin graft to provide an adequate blood supply. This is thought to be superior to revascularization occurring from the margin of the graft alone. We examined histologically the lid margins of two such grafts 2 and 9 months postoperatively. Each demonstrated scarred tarsus and absent meibomian glands. One of the two grafts had loss of cilia. The architecture of the graft tissue otherwise was preserved.     

运用额肌瓣悬吊术重建上睑下垂矫正不佳者的眼部美学单位

目的探讨运用额肌瓣悬吊术重建上睑下垂矫正不佳者眼部美学单位和三维结构的可行性。方法对7例单侧上睑下垂矫正不佳患者,运用额肌瓣悬吊术重建眼部美学单位。术后针对上睑部凹陷、上睑皮纹增多、患侧眉毛代偿性上移、上睑轻度下垂等情况进行随访,并据此评价手术疗效。结果本组患者术后随访3～6个月。6例患者效果明显,1例患者认为手术效果可以接受。手术后无明显并发症。结论运用额肌瓣悬吊术可以有效地恢复上睑下垂矫正不佳患者的眼部美学单位。     

Total upper and lower eyelid reconstruction using an expanded forehead flap

Surgical modalities have been described with varying success for the correction of eyelid defects. The reconstructive surgeon must choose the procedure on a case-by-case basis taking into consideration the following criteria: mechanism of injury, comorbidities, and goals of surgery. In this study, we describe a unique case of total upper and lower eyelid reconstruction using an expanded forehead flap technique in an adult patient who underwent left eye enucleation and radiation to the orbit for rhabdomyosarcoma in infancy. After this patient reached adulthood, examination revealed a contracted, anophthalmic left orbit with paper-thin upper and lower eyelids adhering to the concave walls of the orbit. There was absence of significant periorbital soft tissue. The expanded forehead flap procedure achieved our aims of providing not only an aesthetic result, but also adequate soft tissue support for placement of an ocular prosthesis.     

Prominent ears

This new method for the correction of a prominent ear is original, simple, and efficient. It consists of the retroauricular fixation of the scapha by means of three stitches of polyglycolic acid suture in the posterior auricular muscle after a wide dissection. This results in a transposition of this muscle on the scapha which assures a harmony of the latter with a gentle naturally rounded antihelix. Thus one achieves the main aims of this type of operation with a very simple technique.     

Reconstructive surgery of the leprosy nose: a new approach.

There has still been no reduction in the detection rate worldwide for leprosy, despite supervised multi-drug therapy. In time, leprosy can result in a severe saddle-nose deformity leading to functional problems, disfiguration and stigmatization. In severe cases, only the nasal skin tissue and the lower lateral cartilages are preserved. In such cases, the ideal would be to restore the cartilaginous skeleton but, by contrast with other causes of saddle-nose deformities, this is complicated by the quantity and the poor quality of the remaining nasal mucosa. Leprosy-related saddle-nose deformities are therefore challenging and difficult to reconstruct with the techniques that have been proposed in the past. In this study, 24 patients underwent rhinoplastic surgery involving the use of autogenous costal and/or auricular cartilage or composite grafts. The nasal septum, the upper laterals and the anterior nasal spine were reconstructed with a dorsal onlay attached to a columellar strut with an extension on the proximal side. Before surgery, the saddle-nose deformities were classified according to severity with a new system based on clinical symptoms and signs. Postoperative evaluation was performed at least two years after surgery (N=17). Functional and aesthetic improvement, resorption rate, warping, infection and extrusion were analysed. Functional and aesthetic improvements were achieved in 15/17 patients. None of the patients developed an infection and extrusion or warping of the implants was not observed. The resorption rate depended on the localization and the type of cartilage implant. In general, auricular conchal cartilage implant grafts resulted in less resorption than costal cartilage. Least resorption (4/17 patients) was observed in the dorsal onlay grafts of both conchal (1/6) and costal cartilage grafts (3/11). Resorption of columellar strut implants and shield grafts was observed in 7/17 patients. No resorption was seen of composite grafts (0/4) and alar battens (0/7). Autogenous cartilage implants can be used to reconstruct saddle-nose deformities in leprosy with a minimum risk of complications. The preoperative grade of severity was used as a basis for the development of guidelines for optimal long-term functional and aesthetic outcome.     

Repair of the upper eyelid by means of the prepuce after severe burns

Burns to the eyelid often constitute difficult problems for reconstruction or repair. Functional and aesthetic aspects have to be considered, and suitable donor sites are not readily available in severely burned patients. In male patients, the prepuce yields an almost ideal skin for eyelid repair because of its high elasticity and adequate texture. Two patients with repair of both upper eyelids using the prepuce are demonstrated. The color match of this skin graft is satisfying. If both layers of the prepuce are transplanted, they yield enough tissue to cover both upper eyelids. This method seems to be an adequate method of reconstruction of burned eyelids in severely burned male patients when the usual donor sites for skin grafts are not available.     

Comparison of 1% ropivacaine with 0.75% bupivacaine and 2% lidocaine for peribulbar anaesthesia

We have compared the efficacy of 1% ropivacaine with a mixture of 0.75% bupivacaine and 2% lidocaine for peribulbar anaesthesia in cataract surgery. We used the time to adequate block for surgery, and ocular and eyelid movement scores at 8 min after block as clinical end-points. Ninety patients were allocated randomly to receive 7-10 ml of a mixture of equal parts of 0.75% bupivacaine and 2% lidocaine or an equal volume of 1% ropivacaine alone. Hyaluronidase 15 iu ml-1 was added to both solutions. There were no differences between groups in clinical end- points. Median time at which the block was adequate to start surgery was 8 min (interquartile range 4-10 min) in each group. Median eyelid movement scores were similar in both groups, but the bupivacaine and lidocaine mixture produced a significantly decreased ocular movement score at 2, 4 and 6 min (P < 0.05). There was no difference between groups in the incidence of minor complications. Based on clinical end- points, time to adequate block for surgery and median ocular and eyelid movement scores at 8 min, 1% ropivacaine as the sole agent for peribulbar anaesthesia was comparable with a mixture of 0.75% bupivacaine and 2% lidocaine.      

Total upper eyelid reconstruction

Total upper eyelid reconstruction is required infrequently and is a challenge following trauma or the removal of eyelid for tumor. The vertical forehead flap can provide the external lamella with a mucous membrane graft lining its posterior surface. Two cases of total upper eyelid reconstruction using this method are presented and discussed. Received: 10 August 1998 / Accepted: 19 November 1998     

从东西方人种眼部美学不同特点探讨上睑凹陷的美学缺陷和原因

目的:探讨上睑凹陷对东方人眼部美学的影响,评价其利弊,并纠正某些错误的眼部美学观念和做法。方法:通过将东西方人在眼部和面部的不同解剖、轮廓等特点进行对比,分析其各自的美学特点,展示东方人各种程度上睑凹陷对眼部和面部美学的作用。结果:东方人的上睑凹陷的确对眼部和面部有负面的美学作用,通过对上睑填充脂肪,可以明显改善眼部和面部的外观。结论:东方眼的上睑具有一定的饱满度是美学上所需要的,明显的上睑凹陷对眼部的美观有明显的负面影响。