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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

Cutler-Beard method of reconstruction. (a) Large upper eyelid lesion. (b) After excision and reconstruction with the tarsoconjunctival flap. (c) Advancement flap from cheek
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Figure 5: Cutler-Beard method of reconstruction. (a) Large upper eyelid lesion. (b) After excision and reconstruction with the tarsoconjunctival flap. (c) Advancement flap from cheek

Mentions: A horizontal incision is made in the lower eyelid 4 mm below the lid margin through the entire thickness of the lid and extended vertically below. The conjunctiva and about 1 mm of tarsus, if available, are raised from the inferior fornix. It is advanced and sutured to the upper eyelid defect with 6'0 vicryl with knots on the raw surface. Vertical incisions on the skin are extended and a rectangular flap raised. In older patients, the skin flap can be developed well due to the laxity of skin. Burow's triangle can be excised on either side to give further advancement to the flap [Figure 5a–c]. The skin flap is advanced under the bridge of intact lower eyelid margin and sutured to the skin defect. A cartilage graft from the ear, carved to fit the defect, is sandwiched between the skin and conjunctiva. The medial and lateral ends of the cartilage should be anchored to the remnants of the upper eyelid tarsus. The levator aponeurosis must also be anchored to the cartilage. In younger patients, skin advancement may not be possible. A full thickness skin graft from the postauricular region along with the cartilage graft can be harvested and used as the anterior lamella [Figure 6 a–e]. The division of the flap is done in 6–8 weeks. This is to stretch the tissues. The skin is incised 1–2 mm below the lid margin to compensate for retraction. The conjunctiva is incised giving extra margin to cover the margin of the newly reconstructed lid. The lower lid donor area skin is undermined and sutured, whereas the conjunctiva is not sutured [Figure 5 a–c].


Reconstructions of eyelid defects.

Subramanian N - Indian J Plast Surg (2011)

Cutler-Beard method of reconstruction. (a) Large upper eyelid lesion. (b) After excision and reconstruction with the tarsoconjunctival flap. (c) Advancement flap from cheek
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 5: Cutler-Beard method of reconstruction. (a) Large upper eyelid lesion. (b) After excision and reconstruction with the tarsoconjunctival flap. (c) Advancement flap from cheek
Mentions: A horizontal incision is made in the lower eyelid 4 mm below the lid margin through the entire thickness of the lid and extended vertically below. The conjunctiva and about 1 mm of tarsus, if available, are raised from the inferior fornix. It is advanced and sutured to the upper eyelid defect with 6'0 vicryl with knots on the raw surface. Vertical incisions on the skin are extended and a rectangular flap raised. In older patients, the skin flap can be developed well due to the laxity of skin. Burow's triangle can be excised on either side to give further advancement to the flap [Figure 5a–c]. The skin flap is advanced under the bridge of intact lower eyelid margin and sutured to the skin defect. A cartilage graft from the ear, carved to fit the defect, is sandwiched between the skin and conjunctiva. The medial and lateral ends of the cartilage should be anchored to the remnants of the upper eyelid tarsus. The levator aponeurosis must also be anchored to the cartilage. In younger patients, skin advancement may not be possible. A full thickness skin graft from the postauricular region along with the cartilage graft can be harvested and used as the anterior lamella [Figure 6 a–e]. The division of the flap is done in 6–8 weeks. This is to stretch the tissues. The skin is incised 1–2 mm below the lid margin to compensate for retraction. The conjunctiva is incised giving extra margin to cover the margin of the newly reconstructed lid. The lower lid donor area skin is undermined and sutured, whereas the conjunctiva is not sutured [Figure 5 a–c].

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