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Lower eyelid reconstruction A. Preoperative aspect; B. Postoperative aspect
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Objectives: The paper presents the reconstructive options of the lower eyelid region in patients who have benefited from the excision of basal cell carcinomas.
Methods: The study was based on the clinical and evolutionary particularities analyzed in a series of cases, the patients benefiting from excision and reconstruction for the treatment of bas...
Context in source publication
Citations
... The size of the defect left after the excision was less than one-third of the eyelid margin, which is considered a small defect. Since we also excised a part of the tarsus which needed to be reconstructed to keep the structural integrity of the eyelid -the auricular cartilage which we harvested from the left ear was then placed instead of the excised tarsal part and sutured [3], [4], [5], [6]. Primary closure is usually employed when one-third or less of the eyelid margin is involved -so all of these facts shaped our treatment approach -surgical excision and placement of a cartilage graft, followed by a lateral canthotomy, cantholysis, and local tissue advancement. ...
BACKGROUND: Basal cell carcinoma (BCC) is the most common skin malignancy, and when considering its
predilection for the face – it is most commonly found on the eyelids.
CASE PRESENTATION: In our patient’s case, the BCC was located on the left lower eyelid exemplifying the classic
macroscopic appearance of a nodular basalioma. We took into account all of the patient’s variables (particularly the
lesion’s difficult location) to choose the best surgical approach for excision of the tumor, as well as the reconstructive
strategy that would result in the most functional and aesthetic outcome.
CONCLUSION: In this report, we present a case of our patient with BCC on the lower eyelid, our surgical method for
excision and palpebral reconstruction using an autologous auricular cartilage graft, and the final outcome, which we
consider was the best option for the patient in question.
Background
Reconstructing full-thickness defects involving 50% to 75% of the horizontal length of the lower eyelid after medial and central full-thickness block resection can be challenging. As a disadvanatge, 1-stage reconstructions may require a free graft reconstruction of the posterior lamella. In addition, 2-stage reconstructions are associated with several complications, including erythema, and the eye must be temporarily closed after surgery.
Methods
The present study describes a single-surgeon retrospective case series. Five patients diagnosed with basal cell carcinoma underwent wide full-thickness block resection with optimal excision margins (3–5 mm). Subsequently, 1-stage reconstruction was performed using the modified Mustardé flap, incised using the transconjunctival approach. This flap comprised the skin, muscle, tarsus, and conjunctival flap raised from the lateral canthus through a lateral cantholysis procedure, and then extended to the lateral cheek. The flap was medially transposed to cover the medial and central lower eyelid defect. The superolateral periosteal flap was harvested from the superolateral orbital rim attached to the lateral border of the tarsus of the modified Mustardé flap. The lateral forniceal conjunctiva was released from the retractor and advanced superiorly to cover the inner surface.
Results
The study included 3 men and 2 women, with a mean age of 71 years (range, 62–90 years). Histological evaluations confirmed tumor-free margins in all cases. The average follow-up duration was 20 months (6–60 months), with no tumor recurrence. None of the patients developed long-term complications, such as ectropion, entropion, lagophthalmos, trichiasis, symblepharon, erythema, wound dehiscence, or flap necrosis. All patients had minimal scarring, and no secondary surgical interventions were necessary.
Conclusions
This case series demonstrates the efficacy of the combined modified Mustardé and superolateral periosteal flaps in 1-stage reconstruction of full-thickness defects involving 50% to 75% of the horizontal length of the medial and central lower eyelid without compromising functional and aesthetic outcomes.
Background and Objective: Severe full-thickness eyelid defects seriously endanger the health and
beauty of the ocular surface. It is the most challenging field of oculoplastic and reconstructive surgery to
reconstruct eyelid’s natural appearance and function, in which the posterior eyelid lamella plays an essential
role. Without enough substitute support in eyelids suffered sizeable posterior lamella defects, various
complications may occur, e.g., entropion, ectropion, incomplete eyelid closure, corneal irritation, keratitis,
corneal ulcers, and even vision loss, leading to failure of eyelid reconstruction. This manuscript aimed to
summarize recent advances in posterior eyelid lamella substitutes and summarize the types, advantages, and
disadvantages of the present posterior lamella substitutes in full-thickness eyelid reconstruction.
Methods: A literature search was conducted in the PubMed database to identify relevant publications using
the search algorithm “eyelid reconstruction”. The full-text publication reports about posterior substitutes
from January 2016 to April 2021 in English were selected and reviewed. We also screened relevant research
missed in this search algorithm from the reference lists of specific full-text papers.
Key Content and Findings: A variety of autologous or allogeneic tissues have been reported as
promising techniques for replacing the posterior eyelid lamella in full-thickness and more than 50% length
eyelid defects, e.g., the auricular cartilage, hard palate mucosa, buccal mucosa, nasal septum, and periosteal
flaps, among others. However, various disadvantages have to be considered, i.e., limited sources, surgical
complexity, increased complications, poor mechanical properties, inflammatory immune response, and
the spread of potential infectious diseases. Besides, it provides a novel perspective for posterior lamella
reconstruction to develop new biomaterials with excellent biocompatibility and more physiological
properties, as well as tissue-engineered tarsal and conjunctival tissues with appropriate structure,
biomechanical properties, and specific secretory function similar to the human tarsus.
Conclusions: In summary, our findings suggest that autologous and allogeneic tarsal substitutes are
practical reconstructive technique in current condition, but in the future, in-depth study of new biomaterials
and tissue engineering may provide a novel perspective for the research of tarsal substitutes in oculoplastic
and reconstructive surgery.
Keywords: Eyelid reconstruction; posterior lamella; tarsus; substitute; tissue engineering
Frontiers of Oral and Maxillofacial Medicine
