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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 lower lid defect. (b) Modified Hughes′ procedure, tarsoconjunctival flap from the upper eyelid for the posterior lamella. Skin advancement flap from cheek with Burow's triangle excision
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Figure 10: (a) Moderate lower lid defect. (b) Modified Hughes′ procedure, tarsoconjunctival flap from the upper eyelid for the posterior lamella. Skin advancement flap from cheek with Burow's triangle excision

Mentions: Hughes' tarsoconjunctival flap is a useful and time-tested method. From the upper eyelid a tarsoconjunctival flap is developed 4 mm above the lid margin. This is needed for the stability of the lid margin. In the original method described by Hughes, the tarsoconjunctival flap was raised from the lid margin, which produced problems. The levator aponeurosis is dissected off the flap. Muller's muscle is included but divided at the time of the division of the flap. The width of the flap should be less than the size of the defect. The flap is sutured to the inferior edge of the defect to the conjunctiva and to the tarsal plates on the side with absorbable sutures. The anterior lamella is reconstructed by the advancement flap from the cheek, if the skin is lax, or a full thickness skin graft. The division of the flap is done preferably after 6 weeks to allow stretching of tissues [Figure 9] Extra conjunctiva should be retained in the newly reconstructed lid to form the conjunctival lining of the margin. [Figure 9a–c]. Care should be taken to dissect the Muller's' muscle and divide it to prevent lid retraction which can occur [Figure 10 a–b].


Reconstructions of eyelid defects.

Subramanian N - Indian J Plast Surg (2011)

(a) Moderate lower lid defect. (b) Modified Hughes′ procedure, tarsoconjunctival flap from the upper eyelid for the posterior lamella. Skin advancement flap from cheek with Burow's triangle excision
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 10: (a) Moderate lower lid defect. (b) Modified Hughes′ procedure, tarsoconjunctival flap from the upper eyelid for the posterior lamella. Skin advancement flap from cheek with Burow's triangle excision
Mentions: Hughes' tarsoconjunctival flap is a useful and time-tested method. From the upper eyelid a tarsoconjunctival flap is developed 4 mm above the lid margin. This is needed for the stability of the lid margin. In the original method described by Hughes, the tarsoconjunctival flap was raised from the lid margin, which produced problems. The levator aponeurosis is dissected off the flap. Muller's muscle is included but divided at the time of the division of the flap. The width of the flap should be less than the size of the defect. The flap is sutured to the inferior edge of the defect to the conjunctiva and to the tarsal plates on the side with absorbable sutures. The anterior lamella is reconstructed by the advancement flap from the cheek, if the skin is lax, or a full thickness skin graft. The division of the flap is done preferably after 6 weeks to allow stretching of tissues [Figure 9] Extra conjunctiva should be retained in the newly reconstructed lid to form the conjunctival lining of the margin. [Figure 9a–c]. Care should be taken to dissect the Muller's' muscle and divide it to prevent lid retraction which can occur [Figure 10 a–b].

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