Bipedicle Orbicularis Oculi Flap in the Reconstruction of the Lower Eyelid Ectropion

Background Lower eyelid ectropion is conventionally reconstructed with a local flap or full-thickness skin graft. However, scar contracture and recurrence of ectropion often occur. This article describes an effective surgical technique for lower eyelid ectropion repair using a bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid. Methods This study prospectively analyzed collected data on the bipedicle orbicularis oculi muscle or myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion between 1995 and 2004. The flap was used in 12 eyelid procedures for the correction of lower eyelid ectropion, in 10 cases with traumatic ectropion, and in 1 case with bilateral congenital ectropion. In these cases, a strip of orbicularis oculi muscle or a myocutaneous flap from the upper eyelid with two pedicles attached in the medial and lateral canthus was advanced to the lower eyelid to suspend the eyelid and repair the skin defect. Results No problem of flap viability was encountered in any of the patients, and all healed well. Deformities were corrected, and evaluation showed satisfactory function and appearance during 0.5 to 6 years (average, 2 years) of follow-up evaluation. Eyelid malposition and bulkiness of the lower eyelid occurred in the early stages, but disappeared gradually about 3 months after the operation. There was no flap contraction, recurrent deformity, or significant donor site morbidity in the follow-up period. The incision scars were almost invisible. Conclusions The application of bipedicle orbicularis oculi muscle or a myocutaneous flap from the upper eyelid in reconstruction of lower eyelid ectropion is effective and reduces postoperative morbidity.     

Total upper and lower eyelid reconstruction using deltopectoral flap

Total upper and lower eyelid unilateral full thickness reconstruction is a surgical challenge. A case of right orbital haemangioma with unilateral complete defect of total upper and lower eyelids with right orbital exenteration is reported, together with the surgical technique of reconstruction. Patient was a 24-year-old female who underwent right orbital exenteration with total upper and lower eyelid excision for orbital haemangioma presented after 3 weeks of the above procedure. In the first stage split thickness skin grafting is used to resurface orbital cavity raw area followed by staged reconstruction of total upper and lower eyelid reconstruction using pedicle deltopectoral flap. This reconstruction provided stable eyelid reconstruction to retain ocular prosthesis with concealed and minimal donor area. After reconstruction patient underwent rehabilitation with ocular prosthesis, now the patient is satisfied with cosmetically acceptable results.KEY WORDS: Deltopectoral flap, total eyelid reconstruction, total upper and lower eyelid reconstruction with DP flap     

Total upper and lower eyelid replacement following thermal burn using an ALT flap--a case report.

Upper and lower eyelid unilateral full thickness reconstruction in a patient with no available adjacent tissues because of burns or trauma sequelae is a surgical challenge. A case of severe thermal burn with unilateral complete defect of both upper and lower eyelids is reported, together with the surgical technique of reconstruction. The patient was a 65-year-old man who sustained deep burns of the head and neck with upper airway burns after falling into a fireplace. After tracheostomy and acute resuscitation, he underwent escharectomy and coverage of his head and neck burns with split thickness skin grafts and with full thickness skin grafts to the eyelids. There was incomplete take of the skin grafts to the upper and lower left eyelids. In these areas, infection and loss of the tarsum and subsequent eyelid retraction led to exposure keratitis and blurred vision. After healing and respiratory rehabilitation, he was referred to our microsurgical unit for upper and lower eyelid reconstruction. A free forearm flap was first considered, but the Allen test was negative. Therefore, a free anterolateral thigh (ALT) flap was chosen to provide skin eyelid coverage. The flap was harvested including fascia and centred on one perforator. The levator muscle stump and conjunctiva from both upper and lower cul-de-sacs were dissected and advanced. Flap vessels were anastomosed to the superficial temporal artery and vein. The conjunctiva and the fascia replaced the new inner upper and lower lamella. To our knowledge, this is the first report of the use of a perforator flap, the ALT flap, in full thickness reconstruction of both upper and lower eyelids and may be a reliable option in such selected and challenging situations.     

化学烧伤患者眼睑全层缺损的早期修复

目的探讨化学烧伤导致患眼睑全层缺损后早期修复的时机和方法。方法化学烧伤致眼睑全层缺损患18例(19只眼)。4周内进行游离鼻中膈黏膜软骨瓣 肌皮瓣植皮或皮瓣转移修复，其中4例眼睑再造与角膜移植同时完成。结果再造眼睑及移植角膜全部成活，减少了暴露性角膜炎、角膜溃疡、眼球穿孔等严重并发症的发生。结论化学烧伤致全层眼睑缺损应早期修复，包括为保护视力、减轻炎症进行的眼睑及时再造，和角膜有穿孔危险情况下与角膜移植同期进行的眼睑再造；鼻中膈黏膜软骨是再造眼睑较为理想的材料。     

岛状鼻中隔软骨粘膜瓣修复眼睑结膜和睑板缺损

目的 介绍岛状鼻中隔软骨粘膜瓣修复眼睑结膜和睑板缺损的解剖学基础和3例临床实践。方法 根据解剖研究结果,设计以鼻懵基底动脉和神经为蒂的岛状鼻中隔软骨粘膜瓣,通过眶下区皮下隧道移转到眶区,修复缺损眼睑的结膜和睑板,结果 1998年至今共治疗3例,术后软骨粘膜瓣完全成活,无并发症发生。结论 岛状鼻中隔软骨粘膜瓣血运丰富,易成活,可提供足量的组织用以修复上、下睑或上和下眼睑结膜睑板的缺损,血管神经蒂长,移转灵活,使通过常规方法不能或难以修复的眼睑缺损得以修复,供区隐蔽,无明显继发畸形。     

Eyelid reconstruction with a composite radial forearm palmaris longus tendon flap.

We performed reconstruction with a composite radial forearm palmaris longus tendon flap in patients with wide defects of upper or lower eyelids. In one upper eyelid reconstruction, a palmaris longus tendon was fixed to the frontal muscle to make it possible to open the eye. In the lower eyelid reconstruction, the tendon was fixed to both the medial palpebral ligament and the lateral orbital rim to support the flap. In wide upper and lower eyelid reconstruction with a forearm flap, it is convenient to utilise the palmaris longus tendon to support the flap.     

下睑袋整复术同期矫正内眦赘皮

目的：探讨一种伴有内眦赘皮下睑皮肤松弛者于行下睑袋整复术的同期进行内眦赘皮矫正术,使内眦部位瘢痕隐藏在下睑袋切口上的一项手术方法。方法：2005年1月～2009年12月共为97例下睑皮肤松弛伴内眦赘皮者施行内眦赘皮矫正手术。设计内眦赘皮横行切口线,平行于下睑缘画出下睑袋切口线。横行剪开内眦赘皮的长度达新设计的内眦点,纵行剪开部分内眦韧带前脚,将内眦韧带前脚的内眦侧断端向鼻侧牢固地固定在鼻背筋膜上。常规行下睑袋整复术。结果：97例下睑皮肤松弛伴内眦赘皮者施行矫正手术后,睑裂增大2～4mm,内眦赘皮消失,术后瘢痕位于睑缘下下睑袋切口上隐藏性好,外形满意。结论：该手术方法简单,内眦部位瘢痕隐蔽在下睑袋切口上,效果满意。     

A large lower eyelid reconstruction: nasojugal flaps plus V-Y advancement flap

Lower eyelid reconstruction still represents one of the finest expressions in oculoplastic surgery. A 76-year-old male presented with a basal cell carcinoma (BCC) of the lateral canthus, involving the inferior eyelid. After ablative surgery, the resulting full-thickness defect was reconstructed with a mucosal graft from the buccal sulcus and a nasolabial flap subcutaneously pedicled on a V-Y advancement flap. The above techniques, joined together, allow better nasojugal transposition and should be considered when lateral half of the lower eyelid and lateral canthus reconstruction are performed.     

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.     

双V形切口法Ⅰ期内眦赘皮矫正及重睑成形术

目的探讨一种伴有内眦赘皮单睑者于行切开重睑成形术的同期进行内眦赘皮矫正术,使内眦部位瘢痕隐蔽的一项手术方法。方法设计内眦横行切口线、重睑线和下睑弧形切口线。横行剪开内眦皮肤的长度达新设计的内眦点,纵行剪开部分内眦韧带前脚,将内眦韧带前脚的内眦侧断端向鼻侧牢固地固定在鼻背筋膜上。常规行切开重睑成形术,去除新内眦上端多余小三角形皮肤及下方部分片状眼轮匝肌。沿下睑缘距睫毛下1～2mm处向颞侧弧形切开达下睑“猫耳”消失处,向下分离内眦下方下睑皮瓣,剪除赘皮和部分眼轮匝肌。缝合皮肤,使术后瘢痕隐蔽,睑裂增大,赘皮消失。结果23例46只眼,睑裂增大2～4mm,内眦赘皮消失,重睑形成,内眦部位瘢痕隐蔽,外形满意。结论手术方法简单,内眦部位瘢痕隐蔽,可与切开法重睑成形术同期进行,除2例半年至1年内内眦瘢痕轻度增生外,余均取得满意的疗效,尤其适合于严重的正向型和倒向型内眦赘皮的手术矫正。     

Extensive Periocular Defect Reconstruction with Local Flaps and Conchal Cartilage Graft

BACKGROUND: Advanced, histologically aggressive basal cell carcinomas (BCCs) of eyelids are difficult to eradicate. OBJECTIVE: To describe a case of BCC of both eyelids and lateral canthus and the reconstruction procedures used. METHODS: A two-stage reconstruction procedure was used. First, only mobilization of the forniceal conjunctiva and the musculocutaneous flap technique were used. The because of shortage and insufficiency of the upper eyelid the flap/graft technique was performed. A conchal complex cartilage-perichondrial graft was selected. RESULTS: The described procedure resulted in a very good functional and aesthetic outcome.     

Triple-flap medial canthal reconstruction

A patient with a medial facial defect, following oncological resection involving the medial canthus, nose, upper and lower eyelids, and the cheek, is presented. The defect was reconstructed using a combination of local flaps to provide tissue similar to native tissue, addressing both functional and aesthetic aspects.     

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.     

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.     

Superomedially based upper eyelid musculocutaneous flap for closure of medial canthal defects

The medial canthal region has a complex anatomy and is associated with significant neighboring structures. These features limit reconstructive options and make those procedures difficult. A superomedially based upper eyelid musculocutaneous flap has been designed. Using this flap, which is basically a Tripier flap with a single superomedial pedicle, six medial canthal defects were reconstructed following the resection of benign and malignant lesions. The pedicle was based supramedially and this allowed defects to be reconstructed that included the medial parts of the upper and lower eyelids and resulted in minimal morbidity.     

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.     

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.