Correction of ectropion of the lower lid by upper eyelid skin transposition

A technique for the correction of ectropion of the lower lid by transposition of a full-thickness skin flap from the ipsilateral upper eyelid to the lower lid has been used in seven patients. The technique allows great flexibility in the extent of the approximation of the lower lid to the eye globe. The pedicle is based medially to obtain close contact between the lower punctum and the eye globe. There were no complications. We believe that the eyelid skin flap transposition technique is a useful operation for the correction of moderate to severe senile and paralytic ectropion.     

A dynamic reconstruction of the upper eyelid with a reversed orbital septum flap

We used the reversed orbital septum for reconstruction both of an upper eyelid defect and movement caused by resection of Meibomian carcinoma. The surface of the orbital septum cosmetically had an appearance similar to normal mucosa. This reconstruction was made dynamic by the connection of the orbital septum with levator aponeurosis. The skin defect was closed with surplus skin as a skin-muscle flap. All materials required for this new method were obtained from the recipient's upper eyelid tissues, except for ear cartilage, so that its texture was natural and donor sacrifice was minimal. This procedure requires surplus skin, some area of orbital septum, and connection of the orbital septum with levator aponeurosis. We believe this new procedure provides a good dynamic reconstruction of the upper eyelid.     

Total upper lip reconstruction with a free temporal scalp flap: long-term follow-up

BACKGROUND: In men, reconstruction of large full-thickness defects of the upper lip requires both an inner layer to replace the mucosal lining and an outer hair-bearing layer. METHODS: When locating the superficial temporal vessels, the design of the temporal flap is marked following the hairline needed. After meticulously dissecting the flap, it is inset and microanastomosed with the facial blood vessels. The internal mucosal layer of the flap is grafted on. During the follow-up period, the sensory recovery and motor functions are examined and recorded. RESULTS: The postoperative courses were uneventful, and patients were satisfied with the results. One patient has a long follow-up period of 18 years. CONCLUSIONS: The free temporal scalp hair-bearing flap offers a reasonable alternative to conventional techniques in the reconstruction of large defects of the male upper lip or even a total upper lip. It is a single-staged, relatively simple method of providing hair-bearing skin to the upper lip.     

Experience in upper eyelid reconstruction with the Cutler-Beard technique

Reconstruction of full-thickness upper eyelid defects has to supply a movable lid with perfect corneal protection, good aesthetic quality, and acceptable sequelae at the donor site. The Cutler-Beard procedure, a full-thickness cutaneoconjunctival inferior eyelid advancement flap, is a reliable method for reconstruction of total or partial upper eyelid defects. Especially in older individuals, the skin of the donor site is loose and provides sufficient tissue to stretch. Color and texture of the donor matches the recipient site perfectly. Destabilization or ectropion of the donor site, the lower lid, and retraction or entropion of the recipient site, the upper lid, are the main complications. Therefore, a modification of the classic technique should be considered by implantation of an enforcing inlay in the reconstructed lid (eye bank sclera, fascia lata, ear cartilage), especially in reconstruction of extended defects of the upper lid.     

睑袋整形术Hamra改良术式的临床应用探讨

目的:探讨一种中老年睑袋的整形方法,以矫正中面部老化而出现的下睑皮肤松弛,眶隔脂肪堆积、沟槽畸形,颧部软组织松弛堆积及鼻唇沟加深的改变.方法:对286例睑袋采用Hamra(1995)改良术式,矫正中面部老化的睑袋外观畸形.结果:术后286例随访3月～4年,284例手术效果满意.下睑及颧骨前区皮肤松弛臃肿形态、沟槽畸形、鼻唇沟加深等症状得到明显改善,2例出现轻度下睑退缩.结论:对于中老年性睑袋外观畸形的沟槽畸形、颧骨前区皮肤松弛堆积、鼻唇沟加深等症状采用此法可使中面部老化得到较大的改善.     

Periorbital reconstruction using variations of the upper eyelid flap.

Tissues that have characteristics identical or similar to periorbital soft tissue are preferred for reconstruction in the eye region. The upper eyelid is part of the periorbital area that provides an ideal reserve of tissue for this purpose, without producing a donor-site deformity. We used the upper eyelid flap with different pedicle designs in various parts of the periorbital region in 21 patients, and achieved favourable results. The flap was medially-based in five, superomedially-based in seven, laterally-based in eight, and superolaterally-based in one. The tissue defects were the result of the excision of tumours in 18 patients, and of injury in three. The defects were located in the upper eyelid in two, the lower eyelid in five, the medial canthus in eight, the lateral canthus in four, and in the neighbouring orbitonasal zones in two. Different sized flaps were used according to the dimensions of the defects, which ranged from about 1 to 8 cm2. The upper eyelid flap is versatile, and provides tissue of ideal colour and texture. The procedure can be done quickly in one stage with minimal morbidity.     

The use of free periosteal grafts in extensive lower lid reconstruction

We describe using a scaffold of free periosteum as a posterior lamella replacement in the reconstruction of large defects involving the lower lid. Although the tarsoconjunctival flap is the treatment of choice in lower lid defects, the technique we describe is especially useful in cases in which it is best not to cover the eye for an extended period, and in cases involving defects extending beyond those of the lower lid.     

Treatment of congenital unilateral upper eyelid retraction with a marginal myotomy procedure

Two children with congenital unilateral upper eyelid retraction were treated successfully with surgery at 2 years of age. Excellent results were obtained using a modification of Grove's marginal myotomy procedure for lengthening the levator palpebrae superiorus muscle. To our knowledge, early surgical treatment for this rare idiopathic disorder has not been reported previously.     

Use of the subcutaneously based nasolabial flap in lower eyelid reconstruction.

A 54-year-old male had a history of approximately 18 months, with a diagnostically proven squamous cell carcinoma of the lower left eyelid. The full-thickness subtotal defect was reconstructed with the Hughes procedure (tarsoconjunctival flap) combined with a subcutaneously based nasolabial flap for skin coverage. To our knowledge, the use of the subcutaneous based nasolabial flap in this context has not been described previously. Use of the nasolabial flap may be considered for eyelid reconstruction.     

The reverse auricular flap for the reconstruction of extended defects of the lower eyelid.

The authors present eight cases of lower eyelid reconstruction after extended excision of cutaneous carcinomata. To recreate the supporting function of the lower eyelid it is necessary to reconstruct a rigid structure, which must replace the tarsus and has to be covered by sufficiently thin skin. A condrocutaneous helix island flap, based on the frontal branch of the temporal artery, allows us to reconstruct both lamellae of the eyelid at the same time. The reverse flow to the flap through this vascular pedicle is assured by the anastomotic branches from the supratrochlear and supraorbital arteries. Using this flap we have been able to recreate morphology and function of the lower eyelid with a good cosmetic result in the donor site as well.     

The Valenti procedure for hallux limitus: a long-term follow-up and analysis.

A retrospective analysis of the long-term efficacy of the Valenti procedure for hallux limitus was performed from 1989 to 1997. A total of 33 patients (36 procedures) were selected, surveyed, and examined. Preoperative and postoperative radiographic evaluations and levels of function and pain were obtained from medical records. Complications and patient satisfaction data were collected and reviewed. The patients were evaluated clinically and radiographically. The average age of the patient at the time of surgery was 50.6 years (range, 35-75 years) with an average follow-up of 4.16 years (range, 1-9 years). The average grade of hallux limitus/rigidus was grade II. Five patients were classified as grade I, 23 as grade II, five as grade III, and none as grade IV, based on the modified Drago/Regnauld grading system. Subjective results were calculated based on the American Orthopedic Foot and Ankle Society clinical rating system. Twenty-two patients were rated as having an excellent result, 11 had good results, two had fair results, and one patient had a poor result. We conclude that the Valenti arthroplasty for symptomatic hallux rigidus/limitus is a good procedure for arthritic and degenerated first metatarsophalangeal joints where implant arthroplasty, osteotomy, or arthrodesis are not viable options. Advantages include increased range of motion, decreased postoperative pain, technical ease of performance, maintenance of intrinsic musculature, and rapid return to closed footgear.     

Repair of hallux valgus with a distal soft-tissue procedure and proximal metatarsal osteotomy. A long-term follow-up.

We retrospectively reviewed the results for seventy-five patients (109 feet) in whom a hallux valgus deformity had been corrected with the release of the distal soft tissues, excision of the medial eminence, plication of the medial part of the capsule, and proximal crescentic osteotomy of the first metatarsal. The patients were followed for an average of thirty-four months (range, twenty-four to fifty-six months). The preoperative hallux valgus angle averaged 31 degrees, and the postoperative angle averaged 9 degrees. The preoperative intermetatarsal angle averaged 14 degrees and the postoperative angle, 6 degrees. Ninety-three per cent of the patients were satisfied with the result of the procedure. They stated that, given the same circumstances, they would have the operation again. The most common complication was hallux varus, which occurred in thirteen feet (nine patients). The other complications included recurrence of the hallux valgus in two feet, pain under a fibular sesamoid in one foot, and a tailor's bunion that was unrelated to the operation in one foot. Only five of forty-eight feet that had had a symptomatic plantar keratosis beneath the second metatarsal head preoperatively remained symptomatic postoperatively.     

Orbicularis oculi myocutaneous flap in reconstruction of postburn lower eyelid ectropion.

The management of postburn lower eyelid ectropion is difficult, since the contraction of the skin graft may give rise to secondary deformities especially around the lateral 1/3 of the lower eyelid. In this paper, the results of reconstruction in lower eyelid ectropion with a laterally based orbicularis oculi myocutaneous flap from the upper eyelid in 7 young patients are presented. Satisfactory function and cosmesis were obtained in the evaluation of the patients up to 40 months follow-up. The method proved versatile as the donor scar was well-hidden in the supratarsal fold and the temporally based myocutaneous flap provided additional support to the lower eyelid by exerting an upward pull against the gravity. It is concluded that usage of this flap in postburn ectropion cases is worthwhile to avoid any recurrences. reserved.     

Ear helix flap for reconstruction of total loss of the upper eyelid.

We present a patient with a recurrent carcinoma of the right upper eyelid who underwent resection of the subtotal upper eyelid resulting in a full-thickness defect. The eyelid was reconstructed with advanced conjunctival lining and an ascending helix chondrocutaneous flap from the right auricle. This flap was nourished with a reverse flow of the frontal branch of the superficial temporal vessels. A superficial temporal vein of the flap was anastomosed to the zygomaticofacial branch of the superficial temporal vein at the lateral canthal region to ensure adequate drainage. The flap survived without any congestion. An ascending helix flap is the best candidate for total loss of the upper eyelid.