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Reyes DC, Mattey LR, Rehman U, Gohari SS, Sarwar MS, Brennan PA. Use of the radial forearm free flap in eyelid and orbit defect reconstruction: A systematic review and meta-analysis. J Plast Reconstr Aesthet Surg 2025; 103:204-217. [PMID: 39999689 DOI: 10.1016/j.bjps.2025.01.067] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2024] [Revised: 01/21/2025] [Accepted: 01/25/2025] [Indexed: 02/27/2025]
Abstract
BACKGROUND The radial forearm free flap (RFFF) is widely used in head and neck reconstruction and serves as a versatile option for complex soft tissue eyelid and orbital socket reconstruction, particularly following orbital exenteration. This study evaluated the success and complication rates of RFFF in these contexts. METHODS A literature search of the PubMed, Dynamed, DARE, EMBASE, Cochrane and British Medical Journal electronic databases was conducted (PROSPERO registration number CRD42024584536). RESULTS Twenty-two studies met the inclusion criteria, reporting 40 RFFF procedures in 40 patients (ages: 21-93, M:F 2.1:1). Of these, 65% (n=26) of the RFFFs were used for orbital socket reconstruction, with 75.7% (n=28) performed after cancer resection. The pooled success rate of the RFFFs in orbital and eyelid reconstruction was 92.8% (95% CI, 83.25 to 100, P = 0.39, I² = 5%) and the pooled complication rate was 8.62% (95% CI, 0% to 24.98%, P<0.01, I² = 78%). Flap failure occurred in 10% (n=4) of cases, primarily due to wound dehiscence (n=2). CONCLUSIONS RFFFs demonstrate success and complication rates comparable to traditional flaps used in eyelid and orbital reconstruction, such as the anterolateral thigh, rectus abdominis and latissimus dorsi flaps. It offers functional and cosmetic benefits, particularly for reconstruction after orbital exenteration. The RFFF is a reliable option for complex orbital and eyelid reconstructions and should be considered when local options are unavailable. Standardised reporting and further research are needed to validate long-term outcomes and minimise donor site complications.
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Affiliation(s)
- Daniella C Reyes
- Barts and the London School of Medicine and Dentistry, London, UK.
| | | | - Umar Rehman
- UCL Division of Surgery and Interventional Sciences, University College London, London, UK
| | - Shireen S Gohari
- Department of Otolaryngology and Head and Neck, St. George's Hospital, London, UK
| | - Mohammad S Sarwar
- Department of Oral and Maxillofacial Surgery, Bradford Royal Infirmary, Bradford, UK
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
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Gąsiorowski K, Gontarz M, Bargiel J, Marecik T, Szczurowski P, Wyszyńska-Pawelec G. Reconstructive Techniques Following Malignant Eyelid Tumour Excision-Our Experience. J Clin Med 2024; 13:6120. [PMID: 39458069 PMCID: PMC11508535 DOI: 10.3390/jcm13206120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2024] [Revised: 10/10/2024] [Accepted: 10/12/2024] [Indexed: 10/28/2024] Open
Abstract
Background: Malignant eyelid tumours present a considerable challenge in the field of ophthalmic oncology, necessitating a combination of precision oncological care and meticulous reconstruction to ensure the preservation of eyelid functionality and the maintenance of facial aesthetics. Method: This study presents a review of the outcomes of 167 patients who underwent eyelid reconstruction following the excision of primary non-melanocytic malignant tumours. The choice of reconstruction technique was dependent on a number of factors, including the stage of the tumour, its location, and the characteristics of the patient. The most commonly used techniques included regional flaps, local flaps, and skin grafts. The most frequently employed reconstruction techniques were forehead flaps (59 cases), simple excisions (38 cases), and Mustarde cheek flaps (16 cases). Result: The postoperative complications, including ectropion, epiphora, and flap necrosis, were recorded. However, no significant correlation was found between the risk of complications and either the location of the tumour or the reconstruction method employed. Despite the complexity of medial canthal and lower eyelid reconstruction, satisfactory aesthetic and functional outcomes were generally achieved. Conclusions: This study emphasises the importance of individualised surgical planning, highlighting the advantages and limitations of various techniques to optimise both the functional and aesthetic results.
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Affiliation(s)
- Krzysztof Gąsiorowski
- Department of Cranio-Maxillofacial Surgery, Medical College, Jagiellonian University, 30-688 Cracow, Poland; (M.G.); (J.B.); (T.M.); (P.S.); (G.W.-P.)
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Chaiyasate K, Abdul-hamed S, Lohasammakul S. Aesthetic and Functional Reconstruction of Periorbital Region Using Radial Forearm Free Flap. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5984. [PMID: 39036597 PMCID: PMC11259395 DOI: 10.1097/gox.0000000000005984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 05/31/2024] [Indexed: 07/23/2024]
Abstract
Background This study describes the utilization of the radial forearm free flap (RFFF) for the restoration of severe soft tissue deficiency involving the upper and lower eyelids in three patients. Methods This study is a retrospective review of the senior authors' clinical records for patients who presented with periorbital defect and underwent reconstruction with RFFF between 2018 and 2022. Results As a part of a comprehensive reconstructive surgery, we used the RFFF to deliver an ample amount of well-vascularized soft tissue. The flap's vessels were anastomosed to the ipsilateral facial vessels in all cases. Patients showed significant functional improvement, with complete eyelid closure achieved. No immediate postoperative complications were noted. Conclusions RFFF demonstrated optimal outcomes in upper eyelid reconstruction.
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Affiliation(s)
- Kongkrit Chaiyasate
- From the Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, Mich
| | - Senan Abdul-hamed
- From the Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, Mich
- Department of Surgery, Michigan State University, East Lansing, Mich
| | - Suphalerk Lohasammakul
- From the Department of Plastic and Reconstructive Surgery, Corewell Health East William Beaumont University Hospital, Royal Oak, Mich
- Department of Anatomy, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
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Singh T, Vathulya M, Agrawal A, Behl R, Singh A. A Single Staged Reconstruction of Upper Eyelid and Eyelashes. Indian J Plast Surg 2024; 57:152-155. [PMID: 38774726 PMCID: PMC11105817 DOI: 10.1055/s-0044-1779656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2024] Open
Abstract
The upper eyelid is a complex structural part of the face that plays an important role in protecting the cornea from drying and damage to preserve vision. The eyelashes are an essential part of the upper eyelid and help in protecting the eyes from dust, foreign bodies, and sweat. Being a part of the face, which is the most noticeable part of the body, both structures hold an important role in reconstructive procedures. Reconstruction of both structures simultaneously is tricky but helps reduce the number of procedures required in achieving an aesthetically acceptable eye. Our techniques describe the use of the paramedian forehead flap with an anterior hairline to reconstruct the upper eyelid and eyelashes in a single stage in a posttraumatic near-total upper eyelid defect with a favorable outcome. Depending on the parting of the patient's hair, the anterior hairline of one side can be included in the distal edge of the flap while raising, which can be inset so that the direction and orientation of the eyelashes perfectly match. Our technique refurbishes an established technique for eyelid reconstruction to include eyelash reconstruction at the same time, thus saving time and resources without any inconvenience to the patient.
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Affiliation(s)
- Taruna Singh
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anand Agrawal
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Ridima Behl
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Anupam Singh
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Miotti G, Zeppieri M, Rodda A, Salati C, Parodi PC. How and when of eyelid reconstruction using autologous transplantation. World J Transplant 2022. [DOI: doi.org/10.5500/wjt.v12.i7.175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Miotti G, Zeppieri M, Rodda A, Salati C, Parodi PC. How and when of eyelid reconstruction using autologous transplantation. World J Transplant 2022; 12:175-183. [PMID: 36051449 PMCID: PMC9331409 DOI: 10.5500/wjt.v12.i7.175] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 04/20/2022] [Accepted: 06/18/2022] [Indexed: 02/06/2023] Open
Abstract
Reconstructive surgery of the eyelid after tumor excision, trauma or other causes can be challenging, especially due to the complexities of the anatomic structures and to the necessity of both functional and aesthetic successful outcomes. The aim of this minireview was to investigate the use of tissue transplantation in eyelid reconstruction. Surgical procedures are various, based on the use of both flaps, pedicled or free, and grafts, in order to guarantee adequate tissue reconstruction and blood supply, which are necessary for correct healing. Common techniques normally include the use of local tissues, combining non-vascularized grafts with a vascularized flap for the two lamellae repair, to attempt a reconstruction similar to the original anatomy. When defects are too wide, vast, deep, and complex or when no adjacent healthy tissues are available, distant area tissues need to be recruited as free flaps or grafts and paired with mucosal layer reconstruction. With regards to the anterior lamella, full thickness skin grafts are commonly preferred. With regards to the reconstruction of posterior lamella, there are different graft options, which include conjunctival or tarsoconjunctival, mucosal or palatal or cartilaginous grafts usually combined with local flaps. Free flap transplantation, normally reserved for rare select cases, include the use of the radial forearm and anterolateral flaps combined with mucosal grafts, which are surgical options currently reported in the literature.
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Affiliation(s)
- Giovanni Miotti
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
| | - Marco Zeppieri
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Agostino Rodda
- Department of Medical, Surgical and Health Sciences, Plastic and Reconstructive Surgery Unit, University of Trieste, Trieste 34123, Italy
| | - Carlo Salati
- Department of Ophthalmology, University Hospital of Udine, Udine 33100, Italy
| | - Pier Camillo Parodi
- Department of Plastic Surgery, University Hospital of Udine, Udine 33100, Italy
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Vathulya M, Manohar N, Jagtap MP, Mago V, Jayaprakash PA. Dynamic Upper Eyelid Reconstruction for Total Periorbital Soft Tissue Loss. Arch Plast Surg 2022; 49:319-323. [PMID: 35832141 PMCID: PMC9142252 DOI: 10.1055/s-0042-1748639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Total eyelid defect comprises full-thickness loss of both upper and lower eyelids in a patient. It is a rare and devastating condition with serious implications related to vision, which mandates early and functional reconstruction when associated with intact globe. The primary goal is to give a stable coverage for orbital protection but at the same time provide a functional reconstruction of the defect, to allow for adequate mobility of the eyelids so that the patient's vision is restored to normal with minimal disability. When the defect is massive, and in the absence of loco-regional flaps, microvascular tissue transfer is needed. In this report we describe a radial-artery-based microvascular tissue transfer with a unique innovation utilizing the contralateral frontalis muscle to reconstruct a case of unilateral total upper and lower eyelid loss.
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Affiliation(s)
- Madhubari Vathulya
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nishank Manohar
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Manish Pradip Jagtap
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Vishal Mago
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Praveen A. Jayaprakash
- Department of Burns and Plastic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Shah S, Rakesh D, Goel S, Mittal R, Garg R, Singh K. Postavulsion complete loss of both lids with corneal injury and orbital floor fracture: A surgical challenge. MEDICAL JOURNAL OF DR. D.Y. PATIL VIDYAPEETH 2022. [DOI: 10.4103/mjdrdypu.mjdrdypu_22_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Son TT, Dung PTV, Huy LA. Reconstruction of a massive facial defect with the pre-expanded free anterolateral thigh flap: A case report. Int J Surg Case Rep 2021; 90:106693. [PMID: 34972010 PMCID: PMC8724960 DOI: 10.1016/j.ijscr.2021.106693] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/09/2021] [Accepted: 12/14/2021] [Indexed: 11/01/2022] Open
Abstract
INTRODUCTION AND IMPORTANCE Massive facial defects remain a reconstructive challenge because of the region's unique character and the limitation of a well-matched donor site. Pre-expanded free anterolateral thigh (ALT) flap provides a good alternative for reconstructing massive skin and soft tissue defects. CASE PRESENTATION A 21-year-old male patient presented to our department with a massive right facial degloving wound caused by a sharp edged-weapon attack. The patient left the hospital after 3 weeks of wound care, and only came back to us after 2 months with large defects at the nasal, cheek, and upper and lower right lip regions. The procedure of ALT flap expansion surgery was performed for 2 months. The pre-expanded ALT flap was used for reconstruction of the patient's facial defects. Two-year follow-up showed that the flap at the reconstructed area resembled the contour of the nasal tip, facial skin color similarities in the cheeks and lips, and the patient's mouth had normal function. CLINICAL DISCUSSION The combined pre-expanded and composite ALT free flap techniques allow simultaneous reconstruction of many different anatomic units. Flap debulking helps to improve the nasal contour from the original defect. The lip separation technique and flap debulking procedure help enhance aesthetic reconstructive outcomes of the skin flap. CONCLUSION The surgical reconstruction using a pre-expanded ALT free flap for the patient with a massive facial defect was safe. In particular, sufficient skin and soft tissue ensured facial aesthetics and oral function for the patient when using this method.
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Affiliation(s)
- Tran Thiet Son
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam; Department of Plastic Surgery, Saint Paul Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam; Department of Plastic and Reconstructive Surgery, Hanoi Medical University Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam.
| | - Pham Thi Viet Dung
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam; Department of Plastic Surgery, Saint Paul Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam; Department of Plastic and Reconstructive Surgery, Hanoi Medical University Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam.
| | - Le Anh Huy
- Department of Plastic Reconstructive and Aesthetic Surgery, Bach Mai Hospital, No.78 Giai Phong Street, Hanoi, Viet Nam.
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Fin A, De Biasio F, Lanzetta P, Mura S, Tarantini A, Parodi PC. Posterior lamellar reconstruction: a comprehensive review of the literature. Orbit 2019; 38:51-66. [PMID: 29781746 DOI: 10.1080/01676830.2018.1474236] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 05/03/2018] [Indexed: 06/08/2023]
Abstract
The aim of the review is to describe the different techniques and materials available to reconstruct the tarsoconjunctival layer of the eyelid; to analyze their indications, advantages, and disadvantages. We searched the Cochrane, PubMed, and Ovid MEDLINE databases for English articles published between January 1990 and January 2017 using variations of the following key words: "posterior lamella," "eyelid reconstruction," "tarsoconjunctival," "flap," and "graft." Two reviewers checked the abstracts of the articles found to eliminate redundant or not relevant articles. The references of the identified articles were screened manually to include relevant works not found through the initial search. The search identified 174 articles. Only a few articles with a therapeutic level of evidence were found. Techniques for the posterior lamellar reconstruction can be categorized as local, regional, and distant flaps; tarsoconjunctival, heterotopic, homologous, and heterologous grafts. Several techniques and variations on the techniques exist to reconstruct the posterior lamella, and, for similar indications, there's no evidence of the primacy of one over the other. Defect size and location as well as patient features must guide the oculoplastic surgeon's choice. The use of biomaterials can avoid possible complications of the donor site.
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Affiliation(s)
- Alessandra Fin
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Fabrizio De Biasio
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Paolo Lanzetta
- b Clinic Department of Ophthalmology , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Sebastiano Mura
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Anna Tarantini
- b Clinic Department of Ophthalmology , Ospedale Santa Maria della Misericordia , Udine , Italy
| | - Pier Camillo Parodi
- a Clinic Department of Plastic and Recostructive Surgery , Ospedale Santa Maria della Misericordia , Udine , Italy
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Lalloué C, Aimard R, Vincent PL, Viard R, Comparin JP, Voulliaume D. [Long-term strategy of the initial management of facial burns: About 3 cases]. ANN CHIR PLAST ESTH 2018; 64:112-119. [PMID: 30318108 DOI: 10.1016/j.anplas.2018.06.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2018] [Accepted: 06/07/2018] [Indexed: 10/28/2022]
Abstract
INTRODUCTION The management of facial burns in their acute stage determines most of the sequelae aspect. An initial treatment of good quality should reduce and even prevent scar ransom and should not compromise potential future corrections. This treatment is based on the respect of facial surgery standards and on the use of some particular technical points. CASE REPORTS We described our surgical protocol through three case reports. We are performing a surgical excision of the unhealed lesions between the 12th and 15th postburn day. This excision is followed by a dermoepidermal skin graft in the same operative time. This graft must be harvested from the scalp every time it is possible and must be manually perforated. All the aesthetic units junctions are necessarily respected. Flaps can be necessary at this stage. DISCUSSION AND CONCLUSION The long-term functional and cosmetic results observed in patients with facial burns vary a lot depending on the initial treatment. Patients with severe burns that benefited from an appropriate initial treatment may thus present better results than patients with less severe burns who were badly treated.
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Affiliation(s)
- C Lalloué
- Hôpital Saint-Luc Saint-Joseph, 20, quai Claude-Bernard, 69007 Lyon, France.
| | - R Aimard
- Hôpital Saint-Luc Saint-Joseph, 20, quai Claude-Bernard, 69007 Lyon, France
| | - P-L Vincent
- Hôpital Saint-Luc Saint-Joseph, 20, quai Claude-Bernard, 69007 Lyon, France
| | - R Viard
- Hôpital Saint-Luc Saint-Joseph, 20, quai Claude-Bernard, 69007 Lyon, France
| | - J-P Comparin
- Hôpital Saint-Luc Saint-Joseph, 20, quai Claude-Bernard, 69007 Lyon, France
| | - D Voulliaume
- Hôpital Saint-Luc Saint-Joseph, 20, quai Claude-Bernard, 69007 Lyon, France
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Abstract
This review is considering methods of ectropion surgical treatment, which are based on modern understanding of etiology and pathogenic mechanisms of this eyelid condition. Attention is driven both to monosurgical methods for mild ectropion correction and to combined methods in complicated cases. Special aspects of surgical approach to severe cicatricial ectropion are described.
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Reconstructive surgery of post-burn cicatricial ectropion of upper and lower eyelid. OPHTHALMOLOGY JOURNAL 2016. [DOI: 10.17816/ov9446-51] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
In the article, an outcome analysis of post-burn upper and lower eyelid ectropion repair in 27 patients (49 cases) is presented. The study group included 31 cases (15 males, 2 females, aged 16-67), the control group consisted of 18 cases (5 males, 5 females, aged 2-52). Patients from the control group underwent free skin grafting of upper and lower eyelids. Patients from the study group underwent combined surgery using two different types of Alloplant biomaterial: allogenous tendon fibres and transplant for eyelid plasty. The operation results were assessed by change in ectropion grade, lagophthalmos and interpalpebral width.
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14
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Microvascular Free Flap for Total Eyelid Reconstruction With a Visually Useful Eye. Ophthalmic Plast Reconstr Surg 2016; 32:e109-11. [DOI: 10.1097/iop.0000000000000288] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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15
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Total Upper and Lower Eyelid Reconstruction: A Rare Procedure--A Report of Two Cases. Plast Reconstr Surg 2016; 136:855-859. [PMID: 26397258 DOI: 10.1097/prs.0000000000001600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
UNLABELLED Reconstruction after total amputation of the upper and lower eyelids with preserved globe is rare. The primary goal is immediate corneal protection. The second goal is to restore mobility, occlusion, and facial symmetry. Two women had full-thickness excision of both upper and lower eyelids to treat a melanoma. The reconstruction method required four steps over a period of 5 months. A buccal mucosal graft was used to recreate the conjunctival lining, and an oblique forehead flap was used to recreate the skin. Resection of the flap and replacement by a full-thickness skin graft made it possible to recreate a thin and mobile upper eyelid. Visual acuity remained unchanged, and the eyelids remained functional despite a degree of ptosis and lower eyelid retraction. CLINICAL QUESTION/LEVEL OF EVIDENCE Therapeutic, V.
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Upper and Lower Eyelid Full Thickness Reconstruction Using a Retrograde Postauricular Island Flap. J Pediatr Gastroenterol Nutr 2015; 26:e489-e490. [PMID: 26352361 DOI: 10.1097/scs.0000000000001978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
Upper and lower eyelid full-thickness reconstruction in a patient without available adjacent tissue because of burns or trauma is a surgical challenge. Our patient had severe thermal burns with complete unilateral defects in both the upper and lower eyelids. Although the skin grafts survived, contraction occurred quickly, subsequent ectropion of both the upper and lower eyelids, which could have lead to exposure keratitis and blurred vision. A retrograde postauricular island flap was harvested to provide skin eyelid coverage, and the donor site was directly closed. After another 2 surgeries, normal skin thickness and a color-matched appearance were achieved, and the donor-site scar was almost invisible from the anterior view. To our knowledge, it is rare to use a retrograde postauricular island flap in a full-thickness reconstruction of both the upper and lower eyelids, but the authors have ascertained that this method may be a reliable option in such selected and challenging situations.
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Abstract
Full-thickness palpebral reconstruction is a challenge for most surgeons. The complex structures composing the eyelid must be reconstructed with care both for functional and cosmetic reasons. It is possible to find in literature different methods to reconstruct either the anterior or posterior lamella, based on graft or flaps. Most patients involved in this kind of surgery are elderly. It is important to use easy and fast procedures to minimize the length of the operation and its complications. In our department, we used to reconstruct the anterior lamella by means of a Tenzel or a Mustardé flap, whereas for the posterior lamella, we previously utilized a chondromucosal graft, harvested from nasal septum. Thus, these procedures required general anesthesia and long operatory time. We started using a vein graft for the posterior lamella. In this article, we present a series of 9 patients who underwent complex palpebral reconstruction for oncological reasons. In 5 patients (group A), we reconstructed the tarsoconjunctival layer by a chondromucosal graft, whereas in 4 patients (group B), we used a propulsive vein graft. The follow-up was from 10 to 20 months. The patient satisfaction was high, and we had no relapse in the series. In group A, we had more complications, including ectropion and septal perforations, whereas in group B, the operation was faster and we noted minor complications. In conclusion, the use of a propulsive vein to reconstruct the tarsoconjunctival layer was a reliable, safe, and fast procedure that can be considered in complex palpebral reconstructions.
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Ebrahimi A, Kazemi HM, Nejadsarvari N. Experience with esthetic reconstruction of complex facial soft tissue trauma: application of the pulsed dye laser. Trauma Mon 2014; 19:e16220. [PMID: 25337516 PMCID: PMC4199293 DOI: 10.5812/traumamon.16220] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2013] [Revised: 03/03/2014] [Accepted: 03/08/2014] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Facial soft tissue injury can be one of the most challenging cases presenting to the plastic surgeon. The life quality and self-esteem of the patients with facial injury may be compromised temporarily or permanently. Immediate reconstruction of most defects leads to better restoration of form and function as well as early rehabilitation. OBJECTIVES The aim of this study was to present our experience in management of facial soft tissue injuries from different causes. PATIENTS AND METHODS We prospectively studied patients treated by plastic surgeons from 2010 to 2012 suffering from different types of blunt or sharp (penetrating) facial soft tissue injuries to the different areas of the face. All soft tissue injuries were treated primarily. Photography from all patients before, during, and after surgical reconstruction was performed and the results were collected. We used early pulsed dye laser (PDL) post-operatively. RESULTS In our study, 63 patients including 18 (28.5%) women and 45 (71.5%) men aged 8-70 years (mean 47 years) underwent facial reconstruction due to soft tissue trauma in different parts of the face. Sharp wounds were seen in 15 (23%) patients and blunt trauma lacerations were seen in 52 (77%) patients. Overall, 65% of facial injuries were repaired primary and the remainder were reconstructed with local flaps or skin graft from adjacent tissues. Postoperative PDL therapy done two weeks following surgery for all scars yielded good results in our cases. CONCLUSIONS Analysis of the injury including location, size, and depth of penetration as well as presence of associated injuries can aid in the formulation of a proper surgical plan. We recommend PDL in the early post operation period (two weeks) after suture removal for better aesthetic results.
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Affiliation(s)
- Ali Ebrahimi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
| | - Hossein Mohammad Kazemi
- Trauma Research Center, Baqiyatallah University of Medical Sciences, Tehran, IR Iran
- Corresponding author: Hossein Mohammad Kazemi, Trauma Research Center, Baqiyatallah University of Medical Sciences, P.O. Box: 1436614313, Tehran, IR Iran. Tel.: +98-2188053766, Fax: +98-2188053766, E-mail:
| | - Nasrin Nejadsarvari
- Department of Medical Ethics, Tehran University of Medical Sciences, Tehran, IR Iran
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Abstract
Traumatic facial soft tissue injuries are commonly encountered in the emergency department by plastic surgeons and other providers. Although rarely life-threatening, the treatment of these injuries can be complex and may have significant impact on the patient's facial function and aesthetics. This article provides a review of the relevant literature related to this topic and describes the authors' approach to the evaluation and management of the patient with facial soft tissue injuries.
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Affiliation(s)
- James D Kretlow
- Division of Plastic Surgery, Baylor College of Medicine, Houston, Texas
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Filobbos G, Chapman T, Khan U. Split anterolateral thigh (ALT) free flap for vulva reconstruction: A case report. J Plast Reconstr Aesthet Surg 2012; 65:525-6. [DOI: 10.1016/j.bjps.2011.08.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Accepted: 08/07/2011] [Indexed: 11/24/2022]
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Liu K, Gu B, Chiang CA, Zhang DS, Li Q. Rescue of vision in burn patients with total eyelid loss. Burns 2011; 38:269-73. [PMID: 22014599 DOI: 10.1016/j.burns.2011.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2011] [Revised: 07/02/2011] [Accepted: 07/06/2011] [Indexed: 11/27/2022]
Abstract
OBJECTIVE For severe burn victims suffering from total loss of upper and lower eyelids, skin graft or skin flap is normally used to cover the lesion and to protect the cornea, preventing corneal ulcer and simultaneously preparing for corneal transplantation. However, a new problem arises after the formation of the new palpebral fissure, that is, the reconstructed eyelids cannot open and close like the normal eyelids and the eyeball movement is limited, which exposes the cornea to dry air resulting in ulceration. In this article, we present a simple technique to partially solve this problem. METHODS Five burn victims who lost their eyelids received treatment: stumps of upper and lower eyelids bulbar conjunctiva were dissected and pulled together as the lining of the conjunctival sac. Intermediate split-thickness skin was then immediately grafted as the new eyelids' skin. After 3 months, a 2-cm transverse incision was made 5mm below the normal palpebral fissure to open the conjunctival sac and new 'eyelids' were formed. RESULTS The patients were followed for 2-9 years. No lagophthalmos and xerophthalmia were found. When the patients raised their heads in the supine position, they could see outside. When they bowed their heads, the cornea was protected. Their remaining vision was rescued and an average 0.4 vision recovered. Most of the patients went back to work. CONCLUSION The opening and closing function of the eyelids can partially be replaced by movements of the head and neck using this technique. It seems to be a reliable option to rescue the vision in these types of challenging situations.
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Affiliation(s)
- Kai Liu
- Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Affiliated to School of Medicine Shanghai Jiao Tong University, Shanghai, PR China
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Duteille F, Bellier-Waast F, Perrot P. [Microsurgery and burn sequelae: what is practical use?]. ANN CHIR PLAST ESTH 2011; 56:382-7. [PMID: 21963437 DOI: 10.1016/j.anplas.2011.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 08/23/2011] [Indexed: 10/17/2022]
Abstract
The use of microsurgery in the management of burn sequelae is not a new idea and free flaps have been used in this context since the 1970s. New technologies like negative pressure treatment and skin substitute have certainly decreased the indication of free flaps. The authors with their experience combined to a review of the literature, try to clarify these indications for each anatomical location. From a technical point of view, they find that realizing a free flap for these patients is more complicated (venous damage, lack of donor site who has been burned…). Despite this, microsurgery must still belong in the decision tree and there are some irreplaceable indication specially for hand reconstruction.
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Affiliation(s)
- F Duteille
- Centre des brûlés, service de chirurgie plastique et reconstructrice, hôpital Jean-Monnet, CHU de Nantes, 44093 Nantes cedex 01, France.
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Bouguila J, Ho Quoc C, Viard R, Brun A, Voulliaume D, Comparin JP, Foyatier JL. [Management of eyelid burns]. J Fr Ophtalmol 2011; 34:655-62. [PMID: 21889815 DOI: 10.1016/j.jfo.2011.04.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2011] [Revised: 04/14/2011] [Accepted: 04/15/2011] [Indexed: 10/17/2022]
Abstract
Burns are devastating injuries scarring patients, both physically and psychologically, for life. This remains particularly true for facial burns. Eyelid burns occur in about 10% of thermal injuries and is a considerable challenge for the reconstructive surgeon given the particular anatomy of the eyelids. Reconstruction of the eyelids following burn injuries has been performed by plastic surgeons since the earliest days of reconstructive surgery, yet a consensus on a treatment regime has not been reached and plastic surgeons are divided on the subject. Controversies exist regarding the excision and debridement of eschar, temporary suture and surgical tarsorrhaphy, timing of surgery for eyelid contraction, and the role of full and split-thickness skin grafts in eyelid reconstruction. This paper describes the particularities of the treatment of burned eyelids in our Burn Center.
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Affiliation(s)
- J Bouguila
- Service de chirurgie plastique et reconstructrice, centre des brûlés, hôpital Saint-Joseph Saint-Luc, 20, quai Claude-Bernard, 69365 Lyon, France. bouguila
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Simultaneous upper and lower eyelid reconstruction using a first web space free flap. Ophthalmic Plast Reconstr Surg 2010; 27:e72-3. [PMID: 20924308 DOI: 10.1097/iop.0b013e3181ed355c] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
The authors present a case of near-total upper and lower eyelid defects treated with a first web space free flap after a chemical burn injury. A first web space free flap was raised from the ipsilateral foot and transferred to the defect with its base turned toward the medial canthal area. The first dorsal metatarsal artery and veins were anastomosed to the superficial temporal artery and veins, respectively. The inner layer of the flap was sutured to the advanced upper and lower palpebral conjunctival flap from conjunctival cul-de-sacs, and the outer layer of the flap was sutured to the defected skin. Flap-debulking procedures were carried out 3 times after the microsurgical procedure. Postoperative aesthetic results were good, except for minor problems that included focal symblepharon and sebum formation. The described method could be used as an alternative for total eyelid reconstruction, especially in patients without available local facial tissue because of burns or trauma.
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Medial canthal reconstruction with combined glabellar and orbicularis oculi myocutaneous advancement flaps. J Plast Reconstr Aesthet Surg 2010; 63:1624-8. [DOI: 10.1016/j.bjps.2009.10.034] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 10/04/2009] [Accepted: 10/28/2009] [Indexed: 11/20/2022]
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"Saddle" tailored upper eyelid island myocutaneous flap to repair full-thickness lower eyelid defects after melanoma excision. Ophthalmic Plast Reconstr Surg 2010; 27:55-9. [PMID: 20829728 DOI: 10.1097/iop.0b013e3181e977ba] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE To perform an early melanoma diagnosis and to repair the full-thickness lower eyelid defect with an island upper eyelid myocutaneous flap tailored into a new shape. METHODS Two patients with pigmented lesion involving skin and tarsus of the lower eyelid were reported. Histologic examination, performed after diagnostic punch biopsy, confirmed the diagnosis of in situ melanomas in both cases. A full-thickness excision was done and a single pedicle island myocutaneous flap from the upper eyelid was performed. The flap was designed in a blepharoplastic manner and tunnelized to reach the lower eyelid defect. The flap was tailored into a "saddle" shape, doubled, and folded to restore both the internal and external eyelid walls in a single-stage procedure. RESULTS Good functional and aesthetic results were obtained with no complications. Interestingly enough, the tissue of the internal layer lost the features of skin epithelium due to metaplasia processes and appeared similar to the conjunctiva. After 3 years, no sign of melanoma recurrence was noted. CONCLUSIONS Early diagnosis was performed in both reported lower eyelid melanoma cases. For the reconstruction, a modified upper eyelid island myocutaneous flap tailored into a "saddle" shape was used, which had the advantages of being a single-stage procedure and avoiding mucosa grafts. The technique could also be used to repair full-thickness lower eyelid defects from other causes.
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Guidelines for reconstruction of the eyelids and canthal regions. J Plast Reconstr Aesthet Surg 2010; 63:1420-33. [DOI: 10.1016/j.bjps.2009.05.035] [Citation(s) in RCA: 58] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Revised: 05/06/2009] [Accepted: 05/18/2009] [Indexed: 11/20/2022]
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