LOWER EYELID RECONSTRUCTION IN FULL THICKNESS DEFECTS

Abstract

Background: Eyelid tumor excision, trauma and congenital coloboma are three common causes of eyelid defects requiring surgical reconstruction. A wide variety of surgical techniques are available and reconstruction of the eyelids can range from simple repair to the integration of multiple complex procedures. Knowledge of eyelid anatomy, adequate preoperative planning, and meticulous surgical technique will optimize the anatomical and functional result. The plastic or ophthalmic surgeon must be able to technically execute these techniques to close eyelid defects.
Purpose: is to evaluate the functional, cosmetic outcome and post operative complications following lower eyelid reconstruction using three different techniques for repair of full thickness defects after periorbital tumor excision, trauma or due to congenital coloboma.
Methods: This study was carried out on thirty eyelids (30) of thirty patients who had eyelid tumors (20 cases), trauma (8 cases) or congenital coloboma (2 cases). They were classified into three groups; Group (A) included 12 cases with 1/3 lower lid defect. Group (B) included 10 cases with 1/3 to 2/3 lower lid defect. Group (C) included 8 cases with subtotal lower lid defect.
Results: Eyelid defects were repaired using variable reconstructive techniques: (1) Primary reconstruction (± canthotomy or cantholysis) was performed in 12 cases for small to moderate eyelid defects (about 1/3 of lower lid), (2) Tenzel semicircular flap was used in 10 cases for moderate to large eyelid defects (about 1/3 to 2/3 of lower lid), (3) Hughes flap was performed in 8 cases for large size lower lid defects (more than 1/2 of lower lid).
Cosmetic results of eyelid reconstructive techniques were: Excellent results in 19 cases, satisfactory in 6 cases, accepted in 4 cases and poor in 1 case. Functional results were: Normal results in 24 cases; limited in 5 cases and lost in 1 case. We had 10 treatable post operative complications in 12 out of 30 cases, epiphora occurred in 8 cases of them.
Conclusion: proper management of lower eyelid full thickness defects necessitate good knowledge and well analysis to obtain optimum functional and aesthetic results. Direct closure of the defects should be the first priority, and flaps are more recommended than grafts. Tenzel flap is better than Hughes flap for 1/2 - 2/3 lower lid defects.
Keywords: Eyelid reconstruction, full thickness defect, Hughes flap, Tenzel flap, graft, FTSG, eyelid tumor.