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Staged Surgery with Total Excision and Lamellar Reconstructive for Medium-sized Divided Nevus of the Eyelids.

Lu R, Li Q, Quan Y, Li K, Liu J - Plast Reconstr Surg Glob Open (2015)

Bottom Line: All of the flaps survived well, and all of the donor sites were healed with inconspicuous scarring.The only complication was eyelash sacrifices, and 5 of 6 patients suffered from this complication.Excellent cosmetic results were gained in all patients, with the exception of 1 patient who thought his postoperative appearance was only good because of the impalpable disparity in color and thickness between the skin flaps and recipient sites.

View Article: PubMed Central - PubMed

Affiliation: Department of Orbital Disease and Ocular Tumor, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: To explore a prior treatment strategy for medium-sized (1.5-20 cm) divided nevus of the eyelids.

Methods: Six patients who suffered from divided nevus of eyelids were recruited to this prospective, case series study between July 2008 and January 2014 (4 male and 2 female patients). The patients' ages ranged from 14 to 29 years, with an average age of 24.5 years. All lesions were medium-sized (1.5-20 cm in diameter) and invaded eyelid margins and the posterior lamella of eyelids. Staged surgery involved total excision of lesions and then repair of the defects with advanced skin flaps and tarsoconjunctival flaps. Two staged surgeries were completed at intervals of at least 3 months.

Results: All of the patients were followed up at least 3 months after the second surgery. Malignant transformation and recurrence were not observed. All of the flaps survived well, and all of the donor sites were healed with inconspicuous scarring. The only complication was eyelash sacrifices, and 5 of 6 patients suffered from this complication. Excellent cosmetic results were gained in all patients, with the exception of 1 patient who thought his postoperative appearance was only good because of the impalpable disparity in color and thickness between the skin flaps and recipient sites.

Conclusions: A staged surgery approach with the total excision of lesions and lamellar reconstructive procedures to repair the defect is a reasonable treatment strategy and can achieve satisfactory cosmetic results for medium-sized (1.5-20 cm in diameter) divided nevus of eyelid.

No MeSH data available.


Related in: MedlinePlus

A, The divided nevus in a 28-year-old woman (patient 1), occupying lateral eyelids. The lesions exacerbated rapidly after her procreation. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 3 months after the first-stage surgery. D, Five days after the second-stage surgery. E and F, The specimens of 2 surgeries both were of intradermal type with active cellular proliferation in part of the region (original magnification ×10).
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Figure 1: A, The divided nevus in a 28-year-old woman (patient 1), occupying lateral eyelids. The lesions exacerbated rapidly after her procreation. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 3 months after the first-stage surgery. D, Five days after the second-stage surgery. E and F, The specimens of 2 surgeries both were of intradermal type with active cellular proliferation in part of the region (original magnification ×10).

Mentions: A 28-year-old woman was hospitalized due to a rapid exacerbation of divided nevus of the eyelids after procreation (patient 1). Upon physical examination, 2.1 × 1.7 cm and 2.1 × 1.0 cm sized black granular nevi were located on upper and lower eyelids, respectively (Fig. 1A). The first-stage surgery involved a full-thickness debulking with a bracket-shaped excision of the divided nevus located in upper eyelid (Fig. 2A). Next, the lateral canthus was removed to decrease interfacial surface tension. The gray-line was split, and the residual tarsoconjunctival flap (tarsus and surrounding conjunctiva) was dissociated, mobilized downward, and secured to the remaining medial and lateral tarsal edges to repair the tarsus defect (Fig. 2B). An oblique incision was made to free the lateral region of skin and form a skin flap, and then, the flap was secured to lateral canthus (Fig. 2C). Another triangular skin flap was fashioned from the temporal skin of upper eyelid and transferred into the residual dermis defect (Fig. 2D). The inferior border was trimmed elaborately (Fig. 2E). The tarsoconjunctival flap and pedicled skin flaps were sutured with 5-0 and 6-0 silk sutures to form new eyelid margin. The defects of donor sites were directly closed with 6-0 absorbable sutures. A satisfying outcome was achieved at 5 days post operation (Fig. 1B). The scar became stable over the course of 3 months, and then, the patient underwent the second-stage surgery (Fig. 1C). In the second-stage surgery, the lower eyelid portion of divided nevus was ablated with 1.0 mm of surrounding normal tissue (Fig. 2F). Around 1.5 mm of the tarsus with tarsal conjunctiva on lower eyelid was excised vertically. The tarsoconjunctival flap was prepared from the inferior region and migrated upward to form the posterior lamella of lower eyelid (Fig. 2G). The region surrounding the incision was maintained as a pair of z-flaps by 3 incisions (Fig. 2H). Then, the 2 pedicled z-plasty flaps were interchanged and advanced on the newly built tarsus to cover the cutaneous defect (Fig. 2I). The newly formed eyelid margin was fixed to the lateral tarsal ligament. The appearance of the patient after recovery period was cosmetically excellent (Fig. 1D). The pathologic examination from 2-stage surgeries showed that both defects were of intradermal type with active cellular proliferation in part of the region (Fig. 1E, F).


Staged Surgery with Total Excision and Lamellar Reconstructive for Medium-sized Divided Nevus of the Eyelids.

Lu R, Li Q, Quan Y, Li K, Liu J - Plast Reconstr Surg Glob Open (2015)

A, The divided nevus in a 28-year-old woman (patient 1), occupying lateral eyelids. The lesions exacerbated rapidly after her procreation. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 3 months after the first-stage surgery. D, Five days after the second-stage surgery. E and F, The specimens of 2 surgeries both were of intradermal type with active cellular proliferation in part of the region (original magnification ×10).
© Copyright Policy
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4494508&req=5

Figure 1: A, The divided nevus in a 28-year-old woman (patient 1), occupying lateral eyelids. The lesions exacerbated rapidly after her procreation. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 3 months after the first-stage surgery. D, Five days after the second-stage surgery. E and F, The specimens of 2 surgeries both were of intradermal type with active cellular proliferation in part of the region (original magnification ×10).
Mentions: A 28-year-old woman was hospitalized due to a rapid exacerbation of divided nevus of the eyelids after procreation (patient 1). Upon physical examination, 2.1 × 1.7 cm and 2.1 × 1.0 cm sized black granular nevi were located on upper and lower eyelids, respectively (Fig. 1A). The first-stage surgery involved a full-thickness debulking with a bracket-shaped excision of the divided nevus located in upper eyelid (Fig. 2A). Next, the lateral canthus was removed to decrease interfacial surface tension. The gray-line was split, and the residual tarsoconjunctival flap (tarsus and surrounding conjunctiva) was dissociated, mobilized downward, and secured to the remaining medial and lateral tarsal edges to repair the tarsus defect (Fig. 2B). An oblique incision was made to free the lateral region of skin and form a skin flap, and then, the flap was secured to lateral canthus (Fig. 2C). Another triangular skin flap was fashioned from the temporal skin of upper eyelid and transferred into the residual dermis defect (Fig. 2D). The inferior border was trimmed elaborately (Fig. 2E). The tarsoconjunctival flap and pedicled skin flaps were sutured with 5-0 and 6-0 silk sutures to form new eyelid margin. The defects of donor sites were directly closed with 6-0 absorbable sutures. A satisfying outcome was achieved at 5 days post operation (Fig. 1B). The scar became stable over the course of 3 months, and then, the patient underwent the second-stage surgery (Fig. 1C). In the second-stage surgery, the lower eyelid portion of divided nevus was ablated with 1.0 mm of surrounding normal tissue (Fig. 2F). Around 1.5 mm of the tarsus with tarsal conjunctiva on lower eyelid was excised vertically. The tarsoconjunctival flap was prepared from the inferior region and migrated upward to form the posterior lamella of lower eyelid (Fig. 2G). The region surrounding the incision was maintained as a pair of z-flaps by 3 incisions (Fig. 2H). Then, the 2 pedicled z-plasty flaps were interchanged and advanced on the newly built tarsus to cover the cutaneous defect (Fig. 2I). The newly formed eyelid margin was fixed to the lateral tarsal ligament. The appearance of the patient after recovery period was cosmetically excellent (Fig. 1D). The pathologic examination from 2-stage surgeries showed that both defects were of intradermal type with active cellular proliferation in part of the region (Fig. 1E, F).

Bottom Line: All of the flaps survived well, and all of the donor sites were healed with inconspicuous scarring.The only complication was eyelash sacrifices, and 5 of 6 patients suffered from this complication.Excellent cosmetic results were gained in all patients, with the exception of 1 patient who thought his postoperative appearance was only good because of the impalpable disparity in color and thickness between the skin flaps and recipient sites.

View Article: PubMed Central - PubMed

Affiliation: Department of Orbital Disease and Ocular Tumor, Zhongshan Ophthalmic Center, State Key Laboratory of Ophthalmology, Sun Yat-sen University, Guangzhou, Guangdong, People's Republic of China.

ABSTRACT

Background: To explore a prior treatment strategy for medium-sized (1.5-20 cm) divided nevus of the eyelids.

Methods: Six patients who suffered from divided nevus of eyelids were recruited to this prospective, case series study between July 2008 and January 2014 (4 male and 2 female patients). The patients' ages ranged from 14 to 29 years, with an average age of 24.5 years. All lesions were medium-sized (1.5-20 cm in diameter) and invaded eyelid margins and the posterior lamella of eyelids. Staged surgery involved total excision of lesions and then repair of the defects with advanced skin flaps and tarsoconjunctival flaps. Two staged surgeries were completed at intervals of at least 3 months.

Results: All of the patients were followed up at least 3 months after the second surgery. Malignant transformation and recurrence were not observed. All of the flaps survived well, and all of the donor sites were healed with inconspicuous scarring. The only complication was eyelash sacrifices, and 5 of 6 patients suffered from this complication. Excellent cosmetic results were gained in all patients, with the exception of 1 patient who thought his postoperative appearance was only good because of the impalpable disparity in color and thickness between the skin flaps and recipient sites.

Conclusions: A staged surgery approach with the total excision of lesions and lamellar reconstructive procedures to repair the defect is a reasonable treatment strategy and can achieve satisfactory cosmetic results for medium-sized (1.5-20 cm in diameter) divided nevus of eyelid.

No MeSH data available.


Related in: MedlinePlus