Eyelid reconstruction skin cancer and reconstructive. A number of procedures have been described for upper eyelid reconstruction. Eyelid tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. Original article bilamellar lower eyelid reconstruction with. The fundamental principle for fullthickness eyelid reconstruction is based on reconstructing the subunits of the eyelid, including the. The tarsal plate is no longer taken into consideration. We read with great interest the article by alghoul and colleagues entitled lower eyelid reconstruction. Eyelid reconstruction an oculoplastic surgical coding. Various techniques are used to recreate volume and normal eye appearance. Right lower eyelid reconstruction after skin cancer removal. Lower eyelid defects are common, and a systematic approach to reconstruction of the lower eyelid is required. Eyelid cancer surgery eyelid reconstruction after cancer removal mohs eyelid reconstruction see the gallery about five to ten percent of all skin cancers occur on the eyelids.
The occidental upper eyelid crease is 8 to 9 mm superior to the eyelid margin centrally in men and 8 to 11 mm superior to the margin in women. The anterior lamella was reconstructed with orbicularis muscle advancement and a free skin graft from the ipsilateral upper eyelid. The anterior lamella was reconstructed with orbicularis muscle advancement and a. Its margin just skirts the corneoscleral junction inferiorly. Total upper eyelid reconstruction with mucosalized tarsal. We present a surgical case report of a 73yearold female with melanoma of the left lower eyelid. This depends on the type of skin cancer and technique used to remove it. Zplasty to eliminate tension on the flap advanced medially. Single tarsoconjunctival flap lower eyelid for upper. Volume 2, number 2 eyelid reconstruction 291e grafts in eyelid reconstruction as a basic principle in plastic surgery, grafts should be used when there is an adequate vas cular bed to enhance their survival. If the tumor is basal cell carcinoma or squamous cell carcinoma and the mohs technique is used, then reconstruction would likely be performed at the same.
In full thickness lower eyelid injuries, it will involve both anterior and posterior lamella. It is associated with sun damage and is the least aggressive skin cancer. All asoprs members are boardcertified ophthalmologists who have completed advanced training in eyelid, orbit, tear duct system and facial cosmetic and reconstructive surgery. Haddock the eyelids provide globe protection and preserve vision. When repairing lower eyelid defects, one must ensure proper eyelid closure while avoiding the complications of eyelid notching, entropion and ectropion. The vast majority of eyelid cancers are basal cell carcinomas 90%, followed far behind by squamous cell carcinoma 5%, and melanoma 12%. Because there are many surgical methods to repair and reconstruct the eyelid, the surgeon must determine which technique is most appropriate to restore the natural eyelid contour for each. Various techniques have been described in the literature for eyelid reconstruction. Abstract the repair of fullthickness defects of the lower eyelids poses a challenge because a graft in combination with a flap is typically used to replace either the posterior or anterior lamella. Classification of lower eyelid defects has previously focused on the missing horizontal percentage of the lid. Eyelid reconstruction may be necessary for a variety of reasons besides tumors and their excision. The goals of eyelid reconstruction include structural and functional restoration with an acceptable aesthetic result. Learn vocabulary, terms, and more with flashcards, games, and other study tools.
Unfortunately, these skin cancers are relatively common if you have had a lot of exposure to the sun. The width of the eye, the horizontal palpebral fissure. Eyelid reconstruction codes be aware that procedure codes 67961 excision and repair of eyelid, involving lid margin, tarsus, conjunctiva, canthus or full thickness, may include preparation for skin graft or pedicle flap with adjacent tissue transfer or rearrangement. The most difficult part of this surgery is to create a lid plate eyelid above the lashes from regular lid skin.
Reconstruction of the eyelids, correction of ptosis, and. Knowledge of surgical eyelid anatomy and appropriate preoperative planning are critical in order to perform eyelid reconstruction and minimize complications and the need for reoperation. The lower lid has a gentle s shaped curvature with the lowest point being just lateral to the pupil. Small defects can be directly sutured closed, even if they extend through the full thickness of the eyelid. Columbia, missouri when more than 25% of an eyelid is missing. It does not typically present any postoperative complications. Ahmad takes part of the upper eyelid tarsal plate and moves it into the lower eyelid to reform the lower eyelid margin. The eyelid skin is the thinnest in the body and is often exposed to sunlight. Holds and his team at ophthalmic plastic and cosmetic surgery, inc. This article describes the reconstruction of the lower eyelid in two layers. We apply a wide variety of the most uptodate surgical techniques to make this possible. After photos were taken 3 months after surgeryprocedure. In most dogs, the skin graft is successful, and the appearance of the eyelid is normal after six weeks.
Aesthetic total lower eyelid reconstruction springerlink. What are common problems that need eyelid reconstruction. No one knows your eyes and face like an asoprs surgeon. Eyelid reconstruction is a challenging procedure demanding technical skill and expertise. Trust your eyes and face to a surgeon who specializes in oculofacial plastic surgery. In 2448 hours, the eyepad is removed and the patient can use the eye. The lower eyelid was resected, and a composite nasal cartilagemucosa graft, a skin graft, and a tpf were used to reconstruct the. You may have already had your skin cancer removed by another surgeon, but you feel that you no longer look your best as a result. Reconstruction of the lower eyelid with a rotationadvancement tarsoconjunctival cheek flap. In addition, variations in periorbital structures provide for identifiable differences in ethnicity, gender, and age and display characteristic signs of various emotional states.
Tumor excision and trauma are 2 common causes of eyelid defects requiring surgical reconstruction. The upper and lower eyelid stay connected for 24 weeks. This study indicates significantly higher rates of. A graft is necessary to reconstruct the posterior lamella. Lower eyelid reconstruction ophthalmology coding ask.
The intricate anatomy of the eyelids and face requires precise restoration in order to avoid postoperative functional anesthetic concerns. In all patients, the tumour was radically excised with a 3mm clear cutaneous margin and a 2mm tarsoconjunctival margin under frozen section control. Reconstruction of the lower eyelid seeks to restore both anatomic function and prereconstructive lid aesthetics. Lower eyelid reconstruction by tarsal transposition. Lower eyelid reconstruction following a traumatic full. Unfortunately sun damage, combined with genetics, can lead to skin cancers of the eyelids, including at the lid margin. Full thickness skin grafts in periocular reconstructions. Defects in the eyelid can also arise from trauma or scarring from previous surgeries. Reprinted with permission from muzaffar ar, mendelson bc, adams wp jr. Reconstructions of eyelid defects of the cornea in children and 11.
Lids can be reconstructed by local flaps or by harvesting tissue from other parts of the face and body. Various techniques have been used for reconstruction of extensive lower eyelid defects, but it is difficult to achieve results which are satisfactory, both from a functional and cosmetic viewpoint. Reconstruction of the lower eye lid with a rotation. Indications for full thickness skin grafts were excision of. Other surgeries of the eye include the eyelid lift to remove excess skin and wrinkles, tear duct surgery to treat blockages of the tear drainage ducts, and droopy eyelid repair to correct eyelid obstruction. Principles of periocular reconstruction following excision. The aim of eyelid cancer reconstruction is to reconstruct the eyelid after ensuring the cancerous tissue has been excised. Pdf reconstruction of the eyelids after mohs surgery. As a result, it is often one of the first areas to show sign of aging and sun damage. Eyelid thin skin, areolar tissue, orbicularis occuli ms. It is slow growing and does not spread to the rest of the body. Eyelid cancer excision and reconstruction may be necessary if you have developed a skin cancer on your eyelids.
Reconstruction of periocular defects following excision of cutaneous malignancy can present difficulties for oculofacial and reconstructive surgeons. For reconstruction, as written by mustarde, when the eye. Reconstruction of the lower eyelid by lateral advancement using a. Therefore, combining a nonvascularized graft for one lamella with a vascularized flap for the other should be the rule. A technique for the reconstruction of lower eyelid. During the past two centuries, hundreds of surgical procedures have been described for the purpose of eyelid reconstruction, perhaps because of the great value attached to the eyes and vision by our culture. Reconstruction of the total lower eyelid defect useful. One hundred consecutive caucasian patients were included in the study, 54 women and 46 men.
Attention to the bilaminar eyelid anatomy and canthal support structures, with efforts. Three cases of single stage, bilamellar reconstruction of fullthickness, horizontal, lateral three quarter lower eyelid defects using pedicled island flaps of. Reconstructive eyelid surgery gallery philadelphia pa. Basic principles of eyelid burn scar release involve a thorough, wide, and overcorrecting release of the deformity. When performing eyelid reconstruction, it is important to successfully recreate the eyelid crease for a better cosmetic result. Pdf reconstruction of eyelids defects researchgate. Surgical anatomy of the ligamentous attachments of the lower lid and lateral canthus. Mucosa is provided by mobilizing the bulbar conjunctiva. Eyelid bags and wrinkles at rest result from a combination of skin and muscle laxity andor excess, and fat excess or weakness of the supporting tissues allowing the fat to bulge outwards. In this case, a rotational advancement cheek flap and composite graft were used to reconstruct the lower eyelid. Retrospective case series of 5 patients with lower eyelid basal cell carcinomas abutting the eyelid margin. The best posterior lamellar graft is the patients own tarsoconjunctiva, which can be harvested from the upper eyelid or the contralateral eyelid to fill the lower eyelid defect.
Modified tripier flap in reconstruction of the lower eyelid 109 discussion tripier flap is considered a myocutaneous, bipedicular flap, originating from the upper eyelid and recommended for the reconstruction of defects located in the lower eyelid. How long after the removal of skin cancer on the lower eyelid will i have to wait for any reconstruction surgery. Pdf as the lower eyelid is frequently the site of malignant disease, lower lid replacement is a common task in oculoplastic surgery. Various reconstructive procedures based on common principles, location and size of the. Lower eyelid reconstruction after basal cell carcinoma. Eyelid reconstruction home eyelid reconstruction all images on this website are the copyrighted property of their respective owners and may not be used without express permission from skin cancer and reconstructive surgery center.
Reconstruction of total lower eyelid defects with the. Reconstruction of the eyelids, correction of ptosis, and canthoplasty nicholas t. To describe the use of the temporoparietal fascial flap tpf in the reconstruction of extensive lower eyelid defects in a functioning eye. Structural restoration of the anterior lamella provides skin coverage and blood supply to the eyelid while that of the posterior lamella provides semirigid support to the eyelid and a nonabrasive mucosal surface for normal blinking, which helps keep the ocular surface moist. A sound understanding of the nature of lower eyelid anatomy and function is. The advantages of this technique for large or total upper eyelid reconstruction include the following. Modified tripier flap in reconstruction of the lower eyelid. To report our experience on lid reconstruction in patients with epitheliomas. The tarsal plate is much larger in the upper eyelid than in the lower eyelid. In the past three years, ten patients have been reconstructed using a cheek flap over a chondromucosal graft, after extensive resection of lower. Purposeto explore the clinical effect of the pedicled lower lidsharing flap for fullthickness reconstruction of the upper eyelid. Marlene morales, md rajat ghaiy, md kamel itani, md. Skin cancer is the most common problem requiring eyelid reconstruction. In the unfortunate event of trauma or eyelid cancer, eyelid reconstruction may be necessary to improve eyelid function and preserve vision while maintaining an aesthetically natural appearance.
A new classification incorporating the vertical dimension plast reconstr surg. Pdf to text batch convert multiple files software please purchase personal license. To report on a new onestep technique for the reconstruction of lower eyelid marginal defects. Johns creek 770 6044141 northsidejohns creek medical office 3890 johns creek parkway, ste 240 suwanee, ga 30024. We use a system of vertical subunits to classify defects and guide reconstruction. Reconstruction of fullthickness lower eyelid defects. Eyelid reconstruction austin oculofacial san antonio. Lower eyelid reconstruction following a traumatic full thickness loss. Eyelid reconstruction, though invasive, is often effective for treating eyelid conditions.
Reconstruction of fullthickness lower eyelid defects l. Eyelid reconstruction from one of our experienced doctors at gordon schanzlin new vision institute institute may be necessary due to benign tumors, trauma, or skin cancer affecting the lids. With lower eyelid corrections lower blepharoplasty the skin and muscle is tightened and fat bulges corrected by either removal or repositioning or a. Lower eyelid reconstruction following a traumatic full thickness loss med j malaysia vol 72 no 3 june 2017 201 be larger than the cartilage so that it may form the eyelid margin and conjunctiva.
562 1085 973 1084 975 1418 576 735 682 290 650 155 1155 1143 30 282 945 805 1584 971 977 1368 664 505 834 147 914 1424 1409 1101 349 931