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.     

Transposition of the levator in blepharoptosis using a single superior lid crease incision

In 1999 we introduced the technique of transposition of the levator using a suture to the frontalis muscle for the correction of severe blepharoptosis [16, 17]. This operation was carried out using two skin incisions, one on the superior lid crease and the other at the superior margin of the eyebrow. It was later demonstrated that the levator muscle becomes reinnervated by the facial nerve branches to the frontalis muscle [18]. The results of this procedure have been satisfactory without infections or lagophthalmos [9, 19, 20]. The only limit of this technique is the ability of the patient to contract the frontalis muscle. This limitation, however, applies to any surgical technique which consists of suspension of the eyelid to the frontalis area. After having performed 22 levator transpositions, utilizing two skin incisions, the procedure is now performed with a single skin incision on the superior lid crease. With this modification the technique might be well accepted by those surgeons who deal with the problems of upper eyelid ptosis.     

眼睑恶性肿瘤切除术后自体硬腭黏膜移植眼睑再造

目的 眼睑恶性肿瘤切除术后采用自体硬腭黏膜替代眼睑后层进行眼睑再造，并对其临床效果进行评价。方法1998年1月～2003年10月，对18例（18眼睑）患者行眼睑恶性肿瘤切除术后，局部旋转移位皮瓣或游离皮瓣联合自体硬腭黏膜替代眼睑后层的眼睑再造术。其中男10例，女8例，年龄35～67岁。18例均为重度眼睑缺损，其中眼睑全部缺损12例，2／3眼睑缺损6例。眼睑基底细胞癌10例，睑板腺癌6例，眼睑鳞状细胞癌2例。结果18眼睑术后外观及功能基本恢复正常，闭合完全，无内外翻。术后随访6个月～4年，平均3年2个月，眼睑形态及功能保持稳定，无植片感染及挛缩，无免疫排斥反应，无肿瘤复发。结论自体硬腭黏膜代替眼睑后层作眼睑恶性肿瘤切除术后的眼睑重建术，是一种简便易行、取材方便、术后并发症少、临床效果满意的眼睑再造术，硬腭黏膜优于传统的眼睑后层替代材料。     

异体巩膜移植替代睑板重建眼睑

目的 探讨异体巩膜移植替代睑板重建眼睑的临床效果。方法 1986年5月～2001年1月对45例部分眼睑缺损患者，采用异体巩膜替代睑板行眼睑重建。其中男31例，女14例，上睑18例，下睑27例；累及上或下眼睑内眦都9例，外眦都7例，眼外伤22例，眼睑肿瘤23例。眼睑缺损不超过眼睑总长度的1／2。术后观察重建眼睑的外观、功能及并发症。结果 45例移植异体巩膜行眼睑重建均获成功。术后随访11～38个月，平均19．7个月。重建的眼睑完整，双侧眼睑长度及高度差值均小于2mm。眼睑开闭及上提功能基本正常，对视功能无影响。结论 异体巩膜是替代睑板行眼睑重建的理想材料。     

应用局部皮瓣修复上睑全层缺损一例报告

目的探讨局部皮瓣修复上睑全层缺损的价值。方法2007年3月,对一例狗咬伤所致的右侧上睑全层缺损进行急诊局部皮瓣修复手术。结果术后随访45d,右侧上睑外形满意,功能良好。结论应用局部皮瓣急诊修复眼睑全层缺损,术后效果满意,可避免Ⅱ期手术和睑缘缝合。     

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.     

Aesthetic total lower eyelid reconstruction

This article describes the reconstruction of the lower eyelid in two layers. Mucosa is provided by mobilizing the bulbar conjunctiva; the cutaneous layer is furnished by a laterally based myocutaneous flap from the ipsilateral upper lid. The tarsal plate is no longer taken into consideration. In 24–48 hours, the eyepad is removed and the patient can use the eye. The unaltered neurovascular supply to the flap provides good eyelid function and tone, and the aesthetic result is satisfactory.     

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。     

Photo-assisted analysis of blepharoplasty results

Currently, postoperative evaluation of aesthetic results of blepharoplasties mainly consists of subjective assessment by patients, surgeons, or others. We present an objective photo-assisted evaluation for preoperative planning and postoperative evaluation of blepharoplasties. Thirty-one female patients underwent aesthetic blepharoplasty. All types of blepharoplasties were included. An analysis of standardized pre- and postoperative photographs included measurements of eye fissure height, eye fissure width, lid sulcus height, upper lid height, upper iris coverage, scleral show, position of cornea to palpebra inferior, canthal tilt, an analysis of the architecture, and correction of wrinkles of the upper eyelid. Patients' satisfaction was investigated by a standardized questionnaire. All measured data showed postoperative changes to standard values. Upper eyelid wrinkles showed a significant decrease postoperatively. Most patients were highly satisfied with their results. The methods described in the present study help to evaluate the pre- and postoperative situation in blepharoplasty surgery.     

Schwannoma of upper eyelid: A rare differential diagnosis of eyelid swellings

Schwannoma is a relatively rare benign tumour of peripheral nerve origin. The occurrence of Schwannoma in eyelid is extremely rare. As per our knowledge, only 11 such cases have been reported in the literature so far. We present a case of a 40-year-old man who presented to us with a 2-year history of slowly enlarging, painless mass in his left upper lid with resultant progressive ptosis. Ocular examination was suggestive of a firm, non-tender nodule of size 2 × 1.5 × 1 cm on the left upper lid. The mass was non-adherent to the skin or the underlying tissue. The eyelid skin and conjunctiva were indurated and signs of inflammation were present. The lateral part of eyelid showed presence of an ulcer and the lid function was severely hampered. Provisional clinical diagnosis was that of an eyelid malignancy. With this in mind, the medial part of the lid was excised and reconstructed using a tarso-conjunctival flap from the lower eyelid in conjunction with a skin graft. The histopathology and immunohistochemistry established the diagnosis of Schwannoma. We recommend that Schwannoma be considered in the differential diagnosis of well-circumscribed eyelid swellings.     

外伤性眼睑退缩的手术治疗

目的：探索采用异体巩膜移植行眼睑退缩矫正手术的疗效。方法：自上睑板上缘切断上睑提肌腱膜,或自下睑板下缘切断下睑缩肌,充分分离后使上下睑缘位置恢复正常,在上述腿膜与睑板之间植入 体巩膜片,以使上睑提肌腱膜或下睑缩肌延长。结果：本组18例22只眼,除1例轻度轿正不足和1例发生轻度上睑下垂体,其余均获得成功。结论：采用异体巩膜移植延长上睑提肌腱膜或下睑缩肌,是修复外伤或手术后眼睑退缩的有效手术方法。     

Surgical reconstruction of eyelids

Tumors of the eyelid region are a special entity within the tumors of head and neck. Their early recognition and histologic classification helps to avoid extensive and destructive surgery, which is particularly challenging with regard to the surgical repair of those defects. In 58% of the patients with eyelid tumors treated at Fachklinik Hornheide between 2002 and 2006, a malignant neoplasia was diagnosed. In eyelid surgery, particular principles need to be observed. Provided those guidelines are strictly observed, even extensive defects of the upper or lower eyelid can be repaired in an aesthetically acceptable manner. When reconstructing a lower eyelid, not only restoration of the original structure of the margin of the lower eyelid including the ciliary edge is aimed at but also stabilization of the eyelid especially in reconstruction of the lateral angle of the eye. Static reconstruction is not sufficient in many cases with extensive defects of the upper eyelid. It is necessary not only to replace skin, mucosa, and tarsus, but also to restore mobility and function of the upper eyelid to enable complete eyelid closure to protect the cornea. In the current study, the experience with various techniques of eyelid reconstruction and their functional and aesthetic implications are presented and discussed.     

Eyelid reconstruction using cartilage grafts from auricular scapha

The main goal, in eyelid reconstruction, is to promote an adequate protection to the ocular globe, through the reconstitution of all anatomic plans. In order to obtain adequate stability, cartilage grafts are often used in the repair of the internal lamella. Cartilage grafts from auricular scapha in contact with the bulbar conjunctiva were used in this study. Nineteen patients with various pathologies had 20 eyelid reconstructions using this technique (10 cutaneous tumors, 7 post-traumatic, and 3 cases of lower eyelid retraction). Local cutaneous flaps (glabella, Mustardè, etc) were used to reconstruct the external lamella. Epithelialization on the perichondrium (confirmed by the histological examination) occurs between 3 to 4 weeks. The functional and aesthetic result was considered good in 14 cases (70%), acceptable in 5 (25%) and poor in one case (5%). The donor area showed no complications or deformities. The shape of the scapha allows satisfactory conformation of the graft to the curvature of the ocular globe; it is not flat like the nasal septum, and has a smoother curvature than the auricular concha. Furthermore, it is thinner and that is another reason why the aesthetic result was superior to the technique previously used. The functional results were similar. Received: 20 June 1998 / Accepted: 21 September 1998     

Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns

OBJECTIVE: To evaluate the efficacy of eyelid reconstruction with acellular dermal allograft in patients with eyelid defect after chemical and thermal burns. METHOD: Eyelid reconstruction was performed in 15 eyelids of 13 patients during the period of June 2001-October 2004 by a single senior surgeon (Chen). Among them five patients had thermal burns, and eight patients had chemical burns. The acellular dermal allograft was used as a tarsus substitute that was sutured into the place between the levator aponeurosis in upper lid or retractor in lower eyelid and the remaining tarsus. RESULTS: After a mean follow-up of 9 months, satisfactory function and cosmesis were obtained. No implant rejection or severe complications were observed. CONCLUSION: Acellular dermal allograft may be used safely as a posterior lamellar spacer graft after chemical and thermal burns; the allograft appears to be biocompatible and does not aggravate the inflammation in the injured eyelid.     

针对性系统护理对上睑下垂手术患者术后眼睑美学效果及外观满意度的影响

目的 分析对上睑下垂手术患者实施针对性系统护理的效果及对术后眼睑美学效果及外观满意度 的影响。方法 选取2021年3月-2023年3月于我院行手术治疗的86例上睑下垂患者为研究对象,随机分为 对照组和观察组,各43例。对照组予以常规术后护理,观察组予以针对性系统护理,比较两组眼睑美学效 果、外观满意度及并发症发生情况。结果 观察组双眼睑宽度对称性、上睑轮廓、双眼睑高度对称性评分 均高于对照组（P＜0.05）;观察组外观满意度为97.67%,高于对照组的74.42%（P＜0.05）;观察组并发症 发生率为4.65%,低于对照组的25.58%（P ＜0.05）。结论 对上睑下垂手术患者实施针对性系统护理的效 果良好,可提升术后眼睑美学效果,同时有利于降低并发症发生几率,提高患者的外观满意度。 [关键词] 上睑下垂;眼睑美学效果;针对性系统护理     

The sanctity of the upper lid in lower eyelid reconstruction questioned. A modification of a lid sharing procedure with a long-term follow-up

Sharing techniques using the upper eyelid to reconstruct the lower one have been criticised for causing distortion of the normal upper lid leading to corneal exposure and possible visual disturbance, and for creating second-rate lids. A modification of previously described tarsoconjunctival flap techniques is described which minimises the known complications of earlier methods. A flap of conjunctiva alone is mobilised from the upper eyelid and covered with a full thickness skin graft. A second minor procedure to divide the flap from its donor site is necessary 2 weeks later. Forty-three patients over a 25-year period have undergone total lower eyelid reconstruction with this modified technique and are reviewed with some illustrative cases. Total or subtotal lower eyelid reconstruction is most commonly performed following tumour resection and only occasionally to correct congenital or traumatic defects. The surgical techniques available still cause controversy (Byrd, 1983). An upper lid sharing technique has been criticised for possibly causing a shortened or distorted normal lid (Mustardé, 1981). A modification of this method is described which has been used for over 25 years and has reduced the morbidity of the procedure, leading to acceptable cosmetic and functional long-term results.     

Can Aesthetic Facial Reconstruction Be Judged in Black and White?

Aesthetic considerations of the face need to be evaluated in real-life full color. Staged contouring and insetting of a transferred free flap is sometimes required. This consists of debulking, thinning, and reshaping the flap. If the facial area is involved, however, color mismatch of a free flap represents an aesthetic challenge for the reconstructive surgeon, and often is missed with black and white photos.This article reports on a patient in whom a first dorsal metatarsal cutaneus free flap was used to reconstruct a full-thickness defect in the lateral orbit including upper and lower eyelids and outer canthus. The flap resulted in an unacceptable aesthetic outcome consisting of a bulky, hypopigmented deformity. Revisional surgery consisted of debulking the free flap and resurfacing it with a full-thickness skin graft taken from the postauricular area. This resulted in a pleasant, thin, and better color match reconstruction.The advantages of the first web space of foot free flap to the eyelid are well described. The authors are of the opinion that the flap does not match the color of the eyelid region, and therefore suggest that if used, prefabrication or a second procedure is needed.Evaluation of the postoperative results needs to be in color because black and white can mask the final aesthetic result.     

Upper eyelid mycobacterial infection following Oriental blepharoplasty in a pulmonary tuberculosis patient

Bilateral upper blepharoplasty for the Oriental eyelid was performed in a 20-year-old female on antituberculous therapy for 3 months. The postoperative course was smooth and the patient was back to normal life. But unfortunately, at 3 months after the upper blepharoplasty, a spherical tumescence and red granuloma developed over the right upper eyelid. The granuloma was resected, and on pathological examination the specimen revealed epitheloid granuloma with Langhan's giant cells and a few acid-fast positive bacilli. The clinical events and pathological findings were suggestive of Mycobacterium tuberculosis rather than Mycobacterium chelonei as the possible cause of infection. Thus the patient was advised to continue antituberculous therapy and no antibiotic was prescribed. The eyelid swelling resolved gradually and was completely normal at the end of antituberculous therapy. Though it has been suggested that aesthetic surgery can be performed safely 3 months after antituberculous therapy in a patient with pulmonary tuberculosis, the remote risk of such a complication is always a possibility.     

Reconstruction of full-thickness lower eyelid defects using a blepharoplasty technique with a hard palate mucosal graft.

The authors report a method of reconstruction of a full-thickness lower eyelid defect using a blepharoplasty technique utilizing excess skin of the lower eyelid with a hard palate mucosal graft. In all patients the hard palate mucosa took well, and good functional and aesthetic results were obtained. The most suitable indication of this technique might be for the defect occurring horizontally (for which direct closure is difficult to apply) and located in the lateral side of the lower eyelid (when a large amount of excess skin can be utilized). The authors conclude that although the shape and size of the defect to which this method can be applied is restricted, this is a useful option in the reconstructive methods of a full-thickness lower eyelid defect.     

Biomaterials for tarsal plate reconstruction and our innovative work

Large tarsal plate defect reconstruction is one of the most challenging tasks for plastic surgeons. Based on our practical work and literature review, the techniques and postoperative results of the preserved sclera, ear cartilage, and acellular dermal matrix (ADM) as tarsal plate substitutes were investigated. Two cases were reviewed. Case 1 was a 22-year-old female who had total loss of the right lower eyelid. Ear cartilage (23 ​mm ​× ​25 ​mm) was implanted under the expanded skin during the forehead skin-expanding procedure to form a skin-cartilage-expander capsule compound structure for lower eyelid reconstruction. Case 2 was a 7-year-old boy with a unilateral divided nevus. The lid and conjunctiva of the lower eyelid were invaded. A piece of ADM (12 ​mm ​× ​4 ​mm) was used to repair the tarsal plate defect (12 ​mm ​× ​3 ​mm). The conjunctiva of ADM was covered by itself. An orbicularis oculi myocutaneous flap was used for anterior lamella reconstruction. In case 1, the compound tissue survived and supported the lower eyelid, the lid margin was clear, and the structure was complete over a 1-year follow-up. The aesthetic appearance of the eyelid improved after depilation. It is the first clinical research on the expander capsule as eyelid conjunctiva. In case 2, the conjunctiva completely covered the superior ADM, and the transplant merged with the surrounding tissues without complications after 5 months. The preserved sclera has the longest application history as a tarsal plate substitute. However, it should be preserved in an eye bank and transplanted with conjunctiva repair. Ear cartilage is an autologous tissue that requires conjunctival reconstruction. Our clinical practice was the first to prove the possibility of the expander capsule as eyelid conjunctiva. It is feasible to prefabricate the skin-tarsal conjunctiva complex during the skin expansion procedure. Allogeneic ADM is a common clinical material with advantages of good biological histocompatibility, supportive strength, conjunctivalization, and not requiring donor site surgery. Plastic surgeons are familiar with autologous ear cartilage and ADM, which are easy to obtain and treat. Both ear cartilage and ADM are expected to be the first-line choices in future studies.