Reconstruction of Complex Defects of the Eyelids and Periorbital Region

Document Type : Original Article

Authors

1 The Department of Ophthalmology, Faculty of Medicine, Cairo University

2 The Departments of Surgery, Faculty of Medicine, Cairo University

Abstract

Background: Eyelids and periorbital region defects constitute
a serious problem and significant challenge in the
reconstruction surgery due to difficulty in restoring the anatomy
and the function of the eyelid as well as the aesthetic appearance.
Urgent management is mandatory in all cases. Then
reconstructive plans is designed to restore the anatomy of the
missing part, as well as the different modalities of reconstruction.
Aim: To evaluate the aesthetic and functional results after
reconstruction of the eyelids and periorbital defects by different
reconstructive techniques.
Patients and Methods: This study was conducted on 64
patients with defects of the eyelids and periorbital region.
All patients underwent a full detailed history, complete ocular
examination, visual acuity assessment, photography, and
radiological investigations. Treatment of 45 patients was done
by local flaps, 15 patients by free skin grafts, and 4 patients
by distant flaps.
Results: Patients were evaluated as regards the aesthetic
outcomes and functional results. The results were excellent
in those patients treated by local flaps or free skin grafts. The
distant flaps are used when the defect is large and the local
tissues are not sufficient. In patients treated by split thickness
grafts the results were excellent in 66%; good in 32% and
poor in 2%. In patients treated by local flaps the results were
excellent in 60% and good in 40%. In patients treated by
distant flaps the results were excellent in 52%; good in 43%
and poor in 5%. The functional results were excellent in all
patients except 4 patients treated by local flaps and required
additional split thickness skin graft to correct a mild degree
of ectropion.
Conclusion: Reconstruction of the eyelids defects must
be treated urgently to avoid the serious complications resulting
from exposure of the ocular surface and also to regain the
cosmetic appearance of the face. The various methods presented
in this study may be a guide to help in reconstruction
of the periocular area. It is of utmost importance to maintain
mobility of the upper eyelid and stability of the lower eye lid
while addressing their reconstruction.

Keywords

Main Subjects

References

Burkat C.N. and Lemke B.N.: Anatomy of the orbit and
its related structures. Otolaryngol. Clin. North Am., 38
(05): 825-856, 2005.
2- Sand J.P., Zhu B.Z. and Desai S.C.: Surgical anatomy of
the eyelids. Facial Plast. Surg. Clin. North Am., 24 (02):
89-95, 2016.
3- Fox S.A. and Beard C.: Spontaneous lid repair. Am. J.
Ophthalmology, 58: 947-952, 1964.
4- Yuxin Yan, Rao Fu, Qiumei Ji, Chuanqi Liu, Jing Yang,
Xiya Yin, Carlo M. Oranges, Qingfeng Li and Ru-Lin
Huang: Surgical Strategies for Eyelid Defect Reconstruction:
A Review on Principles and Technique. Ophthalmol.
Ther., 11: 1383-140, 2022.
5- Morley A.M., de Sousa J.L., Selva D. and Malotra R.:
Techniques of upper eyelid reconstruction. Surv. Ophthamol.,
55 (03): 256-271, 2010.
6- Difrancesco L.M., Codner M.A. and McCord C.D.: Upper
eyelid reconstructione. Plast. Reconstr. Surg., 114 (07):
98-107, 2004.
7- Chandler D.B. and Gausas R.E.: Lower eyelid reconstruction.
Otolaryngol. Clin. North Am., 38 (05): 1033-1042,
2005.
8- Mustarde J.C.: 2nd ed. Philadelphia: Churchill Livng
stone. Repair and Reconstruction in the Orbital Region,
1991.
9- Tenzel R.R. and Stewart W.B.: Eyelid reconstruction by
the semicircle flap technique. Ophthalmology, 85: 1164-
9, 1978.
10- Malik A. and Shah-Desai: Sliding tarsal advancement flap
for upper eyelid reconstruction. Orbit, 33 (02): 124-126,
2014.
11- Tenzel R.R.: Reconstruction of the central one half of an
eyelid. Arch. Ophthalmol., 93 (02): 125-126, 1975.
12- Cutler N.L. and Beard C.: A method for partial and total
upper lid reconstruction. Am. J. Ophthalmol., 39 (01): 1-
7, 1955.
13- Levne M.R. and Buckman G.: Semicircular flap revisited.
Arch. Ophthalmol., 104 (06): 915-917, 1986.
14- Meadows A.E. and Manners R.M.: A simle modification
of the glabellar flap in medial canthal reconstruction.
Ophthal. Plast. Reconstr., 19: 313-5, 2003.
15- Mustarde J.C.: The use of flaps in the orbital region. Plast.
Reconstr. Surg., 45 (02): 146-150, 1970.
16- Wilcsek G., Leatherbarrow B. and Francis L.: The "RITE"
use of the Fricke flap in periorbital reconstruction. Eye,
19: 854-60, 2005.
17- Maloof A.J. and Leatherbarrow B.: The glabellar flap
dissected, Eye (Lond), 14 (Pt 4): 597-605, 2000.
18- Sahil A., et al.: Eyelid Reconstruction. American Academy
of Ophthalmology Review, 2022.

Files

Share

How to cite

Statistics