Correction of Lower Lid Retraction Combined with Entropion using an Ear Cartilage Graft in the Anophthalmic Socket

PURPOSE: To investigate the surgical results of an ear cartilage graft and supplemental procedures for correcting lower lid retraction combined with entropion in anophthalmic patients. METHODS: We reviewed retrospectively the medical records of 7 anophthalmic patients with lower lid retraction and entropion, who received a posterior lamellar ear cartilage graft and one or both of lateral tarsal strip or eyelash-everting procedure between March 1998 and March 2003. Preoperative and postoperative lid and socket statuses were also investigated. RESULTS: Ear cartilage grafts were performed in all 7 patients, lateral tarsal strips in 6, and eyelash-everting procedures in 5. Postoperative follow-up durations ranged from 4 to 28 months (average 12.6 months). Retractions were corrected during follow-up in all patients. There were no cases of entropion immediately after surgery. However, the eyelashes of the lower lid returned to an upright position in 4 patients, but not so severe as to touch the ocular prosthesis, and thus did not require surgical correction during follow up. CONCLUSIONS: Lower lid retraction combined with entropion in anophthalmic patients can be corrected effectively using an ear cartilage graft with selective, supplemental procedures.

PREFABRICATION OF AURICLE WITH ABDOMINAL FLAP AND CARTILAGE IN RABBIT

Ear reconstruction with conventional modalities necessitates time consumming, expenses and multi-stage operations, a lot of time, and cost. Although single stage ear reconstruction with vascularized temporoparietal fascia has been developed, it is not always suitable due to precious surgery or trauma. Recently, prefabrication of a secondary island flap by transferring axial vessels and revascularizing target tissues has been attempted. The prefabricated composite secondary island flap can be transferred to other sites by micro-vascular anastomoses of the axial vessels in a second stage operation. In 10 rabbits, a 5x11cm sized bipedicled abdominal flap including panniculus carnosus muscle, concomitantly pedicled on the superficial inferior epigastric vessels was elevated. A 2.5x4cm sired auricular cartilage carried in the shape of a human auricle was tacked on the inner surface of the flap, and the flap was tubed with 4-0 nylon sutures. The abdominal donor wound was primarily closed. At 17 days after elevation, the tubed abdominal flap was trimmed into a human ear shaped composite island flap connected only by the superficial epigastric vascular bundles, and the caudal pole was sutured back to the abdominal skin. Skin surface fluorometry was performed to assess the degree of skin perfusion. The percentage of skin flap survival was recorded 14 days later. The mean Dye Fluorescence Index was 68 14% of normal. Almost 100% of the skin was survived in all rabbits. The histologic study revealed infiltration of homogeneous granulation tissue between the cartilage and flap. The grafted cartilage was healthy and showed normal appearance. Using this principal of ear prefabrication through delay and revascularization of various tissues as an island composite flap, it can be applied in humans with scaring of the temporo-parietal region.