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.     

Upper lid musculocutaneous flap

The use of a musculocutaneous flap from the upper lid for reconstruction in the orbital region and neighboring areas is described. The anatomical basis is considered. Because of its blood supply, the flap can be raised on its lateral or medical pedicle. When based on its lateral pedicle, innervation can be maintained by raising an innervated musculocutaneous flap, which can restore proper lower lid position and tonus. Twenty-two patients were operated on with this technique to fill defects of the lower and upper lid as well as of the lateral nasal wall. All flaps survived, and only minor deformities of the donor site were seen when the eyebrows were included in the flap.     

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.     

Lower eyelid reconstruction preserving symmetry of bilateral palpebral fissure

Summary A method for lower eyelid reconstruction is reported. The lower lid defect is reconstructed with a composite flap including skin and orbicularis oculi muscle from the ipsilateral upper eyelid. To cover the donor eyelid defect, a composite graft (skin and the orbicularis oculi muscle) is taken from the contralateral upper lid. The width of the graft is half of that of the flap so that the resulting contour of the bilateral palpebral fissures is symmetrical. The donor scar is invisible being placed in the natural lid fold. The color and texture match of the reconstructed lower lid is excellent. This is a simple technique which can be done as an outpatient.     

Lower eyelid reconstruction in a paediatric face: a one-stage aesthetic approach using the versatile temporoparietal fascia flap

There are many different lower eyelid reconstruction techniques defined in the literature. Almost all of the published techniques have been described on elderly patients and use upper eyelid, periorbital or facial tissues as donor sites. However, in case of a paediatric patient or a young adult who has a crease-free and scarless face, camouflage of the facial donor-site scar is usually impossible. In order to avoid possible facial donor-site scars and upper eyelid deformities, a technique which uses the temporoparietal fascia (TPF) flap as the framework of a new eyelid was used for the reconstruction of an adolescent patient's postoncologic defect. The inner side of the flap was covered with nasal septal chondromucosal graft and the external side was covered with a retroauricular full-thickness skin graft. Eighteen months of unproblematic follow-up of this overlooked usage of the versatile TPF flap indicates that our technique has proved successful in terms of good functional and cosmetic outcome that is obtained at one stage.     

Modified Tessier flap for reconstruction of the upper eyelid

We present a modification of the Tessier or orbitonasojugal flap for use in upper eyelid reconstruction. It is suitable for repairing full-thickness defects involving 60% or more of the lid margin and has the advantage of being a one-step procedure.     

Complications of eyelid reconstruction using a semicircular flap

Complications of the semicircular flap technique of eyelid reconstruction include lateral canthal webbing, ectropion, lid notching, symblepharon, and tissue fullness of the lateral lid. These difficulties occur infrequently and rarely cause significant problems. Attention to surgical details, however, can minimize unfavorable results. It should be emphasized that the semicircular flap remains a superb technique for reconstruction of defects involving up to 80% of the lower eyelid.     

Transconjunctival versus transcutaneous approach in upper and lower blepharoplasty

In this article, we review the traditional transcutaneous upper lid blepharoplasty technique and contrast it to the newly described transconjunctival upper lid blepharoplasty technique that has limited indications. The technique and application of the skin-muscle flap transcutaneous lower lid blepharoplasty and the transconjunctival lower lid blepharoplasty are also discussed. We prefer the transconjunctival lower lid blepharoplasty as it circumvents the risk of lower eyelid retraction associated with the transcutaneous approach. We also discuss application of adjunctive procedures to the transconjunctival approach to enhance cosmetic results.     

Lower lid “tarsal fixation” blepharoplasty: A personal technique

The majority of patients seeking lower-lid blepharoplasty find that a muscle roll under their lowerlid ciliary margin is a desired postoperative feature. Very few prefer a flat postoperative lower lid. In addition to the cosmetic advantage obtained by more closely simulating a youthful lower eyelid, preservation of the pretarsal portion of the orbicularis oculi muscle also has a physiologic value in maintaining lower eyelid tone and support. A method to create this fold, which included placement of tarsal fixation sutures, has been previously described [1]. It was accompanied by prolonged postoperative swelling. In hands other than masterful surgeons, it often resulted in irregular shape and asymmetry. Perhaps this is why the technique never became very popular. The technique described here consists of overlapping two layers of orbicularis oculi muscle over the lower lid tarsal plate. The method is simple, quick, requires no additional sutures, and does not complicate or prolong the postoperative course. The result is that of a soft, even, and naturalappearing lower eyelid roll and lower eyelid.     

Reconstruction of Lower Eyelid Defects Using a Cross Upper Eyelid Flap Composited with Ear Cartilage

BACKGROUND: Basal cell carcinomas (BCC) most frequently involve the lower eyelid and are treated with total excision. Various techniques have been proposed for reconstruction of the excised eyelid. OBJECTIVE: Because most flaps used in such techniques are bulky, thinner, and aesthetically more favorable, flaps have been sought recently. METHODS: Defects of the lower lid have been closed with a combination of cross-flaps and choncal cartilage prepared from the upper eyelid. RESULTS: Eleven lower lids from 10 patients operated for BCC were reconstructed. All flaps survived. The duration of follow-up was 10 months, and no complications such as relapse, ectropion, or lagophthalmus occurred. CONCLUSIONS: The upper eyelid flap was found to be an appropriate cover for both the skin and the conjunctiva due to its hairless and smooth structure. The outcome in patients followed up for a mean of 10 months was successful, cosmetically and functionally.     

Management of the lower lid in male blepharoplasty

Rejuvenation of the lower eyelid blepharoplasty in men requires consideration of different esthetic norms than those considered in women. Although both require a thorough understanding of anatomy, and the process of aging in each includes descent of the globe, pseudoherniation of the orbital fat, and skeletonization of the inferior bony rim, the goals for male blepharoplasty differ. The authors review the primary surgical approaches in lower lid blepharoplasty (transconjunctival skin-muscle flap) and the currently described techniques used to address displaced orbital fat, with special consideration of the male patient.     

Reconstruction of the levator function and conjunctiva using an inferiorly based orbital septal flap for subtotal full-thickness defects of the upper eyelid: two cases of ocular sebaceous carcinoma

Without using the lower eyelid, functional reconstruction of the tarsoconjunctival layer is challenging for subtotal full-thickness defects of the upper eyelid. In 2 cases of ocular sebaceous carcinoma, the levator function and conjunctiva were reconstructed using the inferiorly based orbital septal flap and conchal cartilage graft. The raw surface of the orbital septal flap was epithelialized within 14 days postoperatively. The new upper eyelid with a stable lid margin could open and close properly. Our surgical procedures may be available in the case that the lower eyelid is not usable.     

Surgical treatment of malignant tumours of the upper lid

Summary In reconstructing an upper lid the importance of having a structure which is composed of skin, tarsal plate and mucous-secreting lining is stressed. This structure must be soft and supple so that it can move, yet must be stiff enough to conform to the shape of the eye. Forehead and other facial flaps are not satisfactory for this purpose and the best material is a full-thickness flap taken from the lower eyelid.The importance of designing the switch-flap accurately so that the hinge will lie in the correct position and the flap will turn up into the upper lid defect without any tension is stressed and details are given of how this can be achieved with any size of upper lid defect, including total loss of the upper lid. The gap created in the lower lid is reconstructed by rotating the cheek and lining it with a free graft of nasal septal mucosa and cartilage.Paper originally read at Meeting of German Plastic Surgery Association, December, 1969.     

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.     

Restoration of lid function in facial palsy with permanent magnets

Summary A method is presented to restore dynamic eyelid function in facial palsy with the implantation of 2 permanent magnets near the upper and lower eyelid margin. The attractive force characteristics of the double magnet system closely simulate the action of the paralyzed orbicularis sphincter. Normal lid opening is accomplished by the intact levators. The width and contour of the palpebral fissure remains undisturbed and is comparable to that of the normal side. The magnetic material used is characterized by a high energy product and coercivity permitting a tiny volume, weight, and size. The siliconized magnets are well tolerated.Near-normal lid function was restored in 10 patients with complete facial palsy, preventing or reversing all symptoms of the paralytic lagophthalmos.This new procedure is advocated as a temporary means to bridge the critical period of time between onset of paralysis and eventual active reinnervation.If long-term observations confirm the good early results it may well serve as a permanent solution for the problem of paralytic lagophthalmos in irreversible facial paralysis.The same principle has been applied successfully to upper lid ptosis.     

Reconstruction of the orbital region with the “blepharoplasty flap”

A modified technique of unipedicled orbicularis oculi myocutaneous flap raised along an upper or lower blepharoplasty incision line for reconstruction of the orbital region is described. This procedure provides excellent aesthetic improvement in older patients with a standard blepharoplasty being performed on the other eyelid.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.     

颊部旋转皮瓣和软骨黏膜复合组织片修复全下睑全层缺损

目的 探索一种全下睑全层缺损Ⅰ期再造的手术方法.方法 对11例患者设计颊部旋转皮瓣再造下睑皮肤,鼻中隔软骨黏膜复合组织片游离移植再造下睑的结膜和睑板,完成Ⅰ期再造全下睑全层缺损.结果 11例再造下睑全部成活,除2例发生再造下睑轻度退缩外,无其他并发症发生,外形及功能均令人满意.结论 采用颊部旋转皮瓣覆盖皮肤,鼻中隔软骨黏膜复合组织移植片替代睑板和结膜行全下睑全层缺损再造,此术式操作简单,效果良好,是全下睑全层缺损再造的理想术式.