Limits...
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, A divided nevus in a 28-year-old man (patient 2), occupying medial eyelids and lacrimal puncta. Extra attention should be paid to the patient because of recurrence after a previous tumorectomy and free skin grafting 10 years ago. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 11 months after the first-stage surgery. D, Three months after the second-stage surgery. E and F, The specimens of 2 surgeries both indicated intradermal type (original magnification ×10).
© Copyright Policy
Related In: Results  -  Collection


getmorefigures.php?uid=PMC4494508&req=5

Figure 3: A, A divided nevus in a 28-year-old man (patient 2), occupying medial eyelids and lacrimal puncta. Extra attention should be paid to the patient because of recurrence after a previous tumorectomy and free skin grafting 10 years ago. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 11 months after the first-stage surgery. D, Three months after the second-stage surgery. E and F, The specimens of 2 surgeries both indicated intradermal type (original magnification ×10).

Mentions: A 28-year-old man with a previous tumorectomy and free skin grafting 10 years ago was admitted to our clinic for evolution of the remnant nevus (patient 2). The recurrent lesion had a diameter of 2.3 × 1.0 cm and 1.3 × 0.6 cm on upper and lower eyelids, respectively. Upon examination, a verrucous nevus affected eyelids, and there was an abnormal chromatosis on palpebral conjunctiva (Fig. 3A). In the first-stage surgery, the patient was treated with a complete wedge excision of the nevus of lower eyelid, including 1.5 mm of adjacent tissue (Fig. 4A). The lower canaliculus lacrimalis was broken after debulking. The anterior and posterior valves were sutured to the skin and conjunctiva, respectively, after splitting the end. Vertical incisions were made from edges of the defect down through the residual tarsus and conjunctiva. The tarsoconjunctival flap was freed from the overlying musculus orbicularis oculi. Similarly, the lateral canthal ligament was partly cut off, and the tarsoconjunctival flap was displaced and secured on the remaining edges (Fig. 4B, C). The region surrounding the incision was maintained as a pair of z-flaps by 3 oblique incisions (Fig. 4D). Those 2 pedicled triangular flaps were interchanged and advanced to the newly built tarsus (Fig. 4E). The marginal tarsus and skin flaps were sutured with 5-0 and 6-0 silk sutures. A lateral canthoplasty was performed to prevent a cat-like appearance. Finally, the twin needle stitch was used to deepen lateral conjunctival capsule. A photograph taken 5 days after the surgery presented a favorable aesthetic result (Fig. 3B). Eleven months later, the second-stage surgery was performed (Fig. 3C). The surgery began with total excision of the nevus of upper eyelid (Fig. 4F). Then, a downward displacement of tarsoconjunctival flap from the superior region and 4 pedicled skin flaps harvested from the nasal and temporal region were successively used to cover the defect of upper eyelid (Fig. 4G–K). The 4 skin flaps were pieced together, and the newly formed inferior border was trimmed (Fig. 4L). The surgery ended with the reconstruction of upper lateral canaliculus. The postoperative appearance was displayed (Fig. 3D). Histology confirmed the features were consistent with an intradermal type nevus (Fig. 3E, 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, A divided nevus in a 28-year-old man (patient 2), occupying medial eyelids and lacrimal puncta. Extra attention should be paid to the patient because of recurrence after a previous tumorectomy and free skin grafting 10 years ago. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 11 months after the first-stage surgery. D, Three months after the second-stage surgery. E and F, The specimens of 2 surgeries both indicated intradermal type (original magnification ×10).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4494508&req=5

Figure 3: A, A divided nevus in a 28-year-old man (patient 2), occupying medial eyelids and lacrimal puncta. Extra attention should be paid to the patient because of recurrence after a previous tumorectomy and free skin grafting 10 years ago. B, Five days after the first-stage surgery. C, A photograph before the second-stage surgery and 11 months after the first-stage surgery. D, Three months after the second-stage surgery. E and F, The specimens of 2 surgeries both indicated intradermal type (original magnification ×10).
Mentions: A 28-year-old man with a previous tumorectomy and free skin grafting 10 years ago was admitted to our clinic for evolution of the remnant nevus (patient 2). The recurrent lesion had a diameter of 2.3 × 1.0 cm and 1.3 × 0.6 cm on upper and lower eyelids, respectively. Upon examination, a verrucous nevus affected eyelids, and there was an abnormal chromatosis on palpebral conjunctiva (Fig. 3A). In the first-stage surgery, the patient was treated with a complete wedge excision of the nevus of lower eyelid, including 1.5 mm of adjacent tissue (Fig. 4A). The lower canaliculus lacrimalis was broken after debulking. The anterior and posterior valves were sutured to the skin and conjunctiva, respectively, after splitting the end. Vertical incisions were made from edges of the defect down through the residual tarsus and conjunctiva. The tarsoconjunctival flap was freed from the overlying musculus orbicularis oculi. Similarly, the lateral canthal ligament was partly cut off, and the tarsoconjunctival flap was displaced and secured on the remaining edges (Fig. 4B, C). The region surrounding the incision was maintained as a pair of z-flaps by 3 oblique incisions (Fig. 4D). Those 2 pedicled triangular flaps were interchanged and advanced to the newly built tarsus (Fig. 4E). The marginal tarsus and skin flaps were sutured with 5-0 and 6-0 silk sutures. A lateral canthoplasty was performed to prevent a cat-like appearance. Finally, the twin needle stitch was used to deepen lateral conjunctival capsule. A photograph taken 5 days after the surgery presented a favorable aesthetic result (Fig. 3B). Eleven months later, the second-stage surgery was performed (Fig. 3C). The surgery began with total excision of the nevus of upper eyelid (Fig. 4F). Then, a downward displacement of tarsoconjunctival flap from the superior region and 4 pedicled skin flaps harvested from the nasal and temporal region were successively used to cover the defect of upper eyelid (Fig. 4G–K). The 4 skin flaps were pieced together, and the newly formed inferior border was trimmed (Fig. 4L). The surgery ended with the reconstruction of upper lateral canaliculus. The postoperative appearance was displayed (Fig. 3D). Histology confirmed the features were consistent with an intradermal type nevus (Fig. 3E, 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