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Reconstructions of eyelid defects.

Subramanian N - Indian J Plast Surg (2011)

Bottom Line: Many a times, the defects involve more than one area.One layer should have the vascularity to support the other layer which can be a graft.A proper plan and execution of it is very important.

View Article: PubMed Central - PubMed

Affiliation: Professor Emeritus Oculoplastic Surgery. Sankara Nethralaya; Senior Plastic Surgeon Apollo Hospital, Retired Professor and Head of the Department of Burns, Plastic and Reconstructive Surgery Kilpauk Medical college and Hospital, Chennai, India.

ABSTRACT
Eyelids are the protective mechanism of the eyes. The upper and lower eyelids have been formed for their specific functions by Nature. The eyelid defects are encountered in congenital anomalies, trauma, and postexcision for neoplasm. The reconstructions should be based on both functional and cosmetic aspects. The knowledge of the basic anatomy of the lids is a must. There are different techniques for reconstructing the upper eyelid, lower eyelid, and medial and lateral canthal areas. Many a times, the defects involve more than one area. For the reconstruction of the lid, the lining should be similar to the conjunctiva, a cover by skin and the middle layer to give firmness and support. It is important to understand the availability of various tissues for reconstruction. One layer should have the vascularity to support the other layer which can be a graft. A proper plan and execution of it is very important.

No MeSH data available.


Related in: MedlinePlus

(a) Moderate-sized defect of the upper eyelid. (b) Mustarde's lid switch from the lower lid. (c) After division
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Figure 4: (a) Moderate-sized defect of the upper eyelid. (b) Mustarde's lid switch from the lower lid. (c) After division

Mentions: The defect in the upper eyelid is transferred to the lower eyelid. Its mid point is marked. This forms the hinge (H) of the flap. The flap is designed on the medial or lateral side depending on the availability of the tissue. From the length of the flap, 25% of the lid length should be reduced. The stretchability of the lid allows the primary closure of the lid up to 25% loss. The reconstructed lid should be firm. The mobility would be affected if it is lax. The length of the flap should be at least 7 mm, otherwise it would not survive.[2] The height depends on the height of the defect.[2] The lid is incised full thickness except at the site of the hinge; it should stop 3 mm from the lid margin on the skin and little less on the conjunctival side. This is to protect the marginal vessel which is 2–3 mm from the lid margin on the anterior surface of the tarsus. The donor area is closed primarily in layers, except at the margin. If there is tension in approximation, lateral lower canthotomy can be done. The switch flap is swung into the defect and sutured in layers. In larger flaps, the levator aponeurosis must be anchored well to the tarsal plate. The bridge flap can be divided anytime after 2 weeks. For larger defects, 75% of the lower lid can be switched along with the reconstruction of the lower eyelid by the cheek rotation flap. The defect is transferred to the lower lid. A quarter of the lid length is marked from the lateral end of the defect. This forms the hinge. The flap is marked on the medial side of the hinge. The size should be the size of the defect minus one-fourth of the lid length. The flap is incised full thickness except at the hinge where it is stopped 4 mm from the lid margin. On the conjunctival side, the incision can be more as the marginal vessel is on the anterior surface of the tarsal plate. The skin lateral to the canthus is raised along with the remnant of the lower lid and mobilized medially. The switch flap is swung into the defect and sutured [Figure 4a–c]. The switch flap is the only method of reconstruction which gives natural-looking lashes to the upper eyelid. The drawbacks are edema which may persist for a long period, and total loss of flap. Extensive dissection is needed if the entire lower lid is to be reconstructed.


Reconstructions of eyelid defects.

Subramanian N - Indian J Plast Surg (2011)

(a) Moderate-sized defect of the upper eyelid. (b) Mustarde's lid switch from the lower lid. (c) After division
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3111123&req=5

Figure 4: (a) Moderate-sized defect of the upper eyelid. (b) Mustarde's lid switch from the lower lid. (c) After division
Mentions: The defect in the upper eyelid is transferred to the lower eyelid. Its mid point is marked. This forms the hinge (H) of the flap. The flap is designed on the medial or lateral side depending on the availability of the tissue. From the length of the flap, 25% of the lid length should be reduced. The stretchability of the lid allows the primary closure of the lid up to 25% loss. The reconstructed lid should be firm. The mobility would be affected if it is lax. The length of the flap should be at least 7 mm, otherwise it would not survive.[2] The height depends on the height of the defect.[2] The lid is incised full thickness except at the site of the hinge; it should stop 3 mm from the lid margin on the skin and little less on the conjunctival side. This is to protect the marginal vessel which is 2–3 mm from the lid margin on the anterior surface of the tarsus. The donor area is closed primarily in layers, except at the margin. If there is tension in approximation, lateral lower canthotomy can be done. The switch flap is swung into the defect and sutured in layers. In larger flaps, the levator aponeurosis must be anchored well to the tarsal plate. The bridge flap can be divided anytime after 2 weeks. For larger defects, 75% of the lower lid can be switched along with the reconstruction of the lower eyelid by the cheek rotation flap. The defect is transferred to the lower lid. A quarter of the lid length is marked from the lateral end of the defect. This forms the hinge. The flap is marked on the medial side of the hinge. The size should be the size of the defect minus one-fourth of the lid length. The flap is incised full thickness except at the hinge where it is stopped 4 mm from the lid margin. On the conjunctival side, the incision can be more as the marginal vessel is on the anterior surface of the tarsal plate. The skin lateral to the canthus is raised along with the remnant of the lower lid and mobilized medially. The switch flap is swung into the defect and sutured [Figure 4a–c]. The switch flap is the only method of reconstruction which gives natural-looking lashes to the upper eyelid. The drawbacks are edema which may persist for a long period, and total loss of flap. Extensive dissection is needed if the entire lower lid is to be reconstructed.

Bottom Line: Many a times, the defects involve more than one area.One layer should have the vascularity to support the other layer which can be a graft.A proper plan and execution of it is very important.

View Article: PubMed Central - PubMed

Affiliation: Professor Emeritus Oculoplastic Surgery. Sankara Nethralaya; Senior Plastic Surgeon Apollo Hospital, Retired Professor and Head of the Department of Burns, Plastic and Reconstructive Surgery Kilpauk Medical college and Hospital, Chennai, India.

ABSTRACT
Eyelids are the protective mechanism of the eyes. The upper and lower eyelids have been formed for their specific functions by Nature. The eyelid defects are encountered in congenital anomalies, trauma, and postexcision for neoplasm. The reconstructions should be based on both functional and cosmetic aspects. The knowledge of the basic anatomy of the lids is a must. There are different techniques for reconstructing the upper eyelid, lower eyelid, and medial and lateral canthal areas. Many a times, the defects involve more than one area. For the reconstruction of the lid, the lining should be similar to the conjunctiva, a cover by skin and the middle layer to give firmness and support. It is important to understand the availability of various tissues for reconstruction. One layer should have the vascularity to support the other layer which can be a graft. A proper plan and execution of it is very important.

No MeSH data available.


Related in: MedlinePlus