Colgajos o injertos cutáneos para la corrección de defectos palpebrales de gran tamaño / Flaps or cutaneous grafts for the correction of large eyelid defects

Objetivo: Describir los resultados estéticos y funcionales con el uso de colgajos o injertos cutáneos en la corrección de defectos palpebrales de gran tamaño. Métodos: Se realizó un estudio observacional, descriptivo, prospectivo, de 15 pacientes con lesiones tumorales o cicatrizales que provocaron defectos palpebrales de gran tamaño, desde enero a diciembre del año 2016, en la Consulta de Oculoplastia del Instituto Cubano de Oftalmología Ramón Pando Ferrer. Resultados: El 73,3 por ciento de los pacientes fue del sexo masculino y mayores de 60 años. Las lesiones tumorales representaron el 73,3 por ciento y el carcinoma basal el 53,3 por ciento. El párpado inferior fue el más comprometido. En el 60 por ciento de los casos se realizó colgajo cutáneo; de ellos, a 8 pacientes (88,8 por ciento) de tipo Tenzel. En el 73,3 por ciento de los pacientes no se presentaron complicaciones. El hematoma posquirúrgico fue la complicación general más frecuente (25 por ciento). Conclusiones: Los defectos palpebrales de gran tamaño se presentan en mayor cantidad en los pacientes mayores de 60 años, del sexo masculino. Predomina el carcinoma basal en el párpado inferior. La técnica reconstructiva con colgajos e injertos cutáneos resulta efectiva en la mayoría de los casos y se reporta un mínimo de complicaciones(AU)

Objective: To describe the esthetic and functional results of the use of flaps or cutaneous grafts for the correction of large eyelid defects. Method: A prospective, descriptive and observational study of 15 patients with tumoral or scar lesions that caused large eyelid defects was conducted from January to December, 2016 in the Oculoplasty Service of Ramon Pando Ferrer Cuban Institute of Ophthalmology. Results: In the study, 73.3 percent of patients were males aged over 60 years. Tumoral lesions were present in 73.3 percent of patients whereas basal carcinoma was found in 53.3 percent. The lower eyelid was the most affected. Sixty percent of cases were corrected with cutaneous flap, eight of them (88.8 percent) with Tenzel-type flap. No complications were seen in 73.3 percent of patients. Postsurgical hematoma was the most common complication (25 percent). Conclusions: Large eyelid defects were observed in a higher number of male patients aged 60 years. Basal carcinoma in the lower eyelid predominated. The reconstructive technique using flaps or cutaneous grafts proved to be effective in most of the cases, with minimal complications(AU)

Large full thickness medial canthal reconstruction: a report of two cases and review of literature

The reconstruction of the upper eyelid with medial canthal involvement post extensive removal of malignant tumour remains a challenge. Proper eyelid reconstruction is necessary to re-establish anatomic integrity, restoration of its functions and to maintain the best cosmetic appearance. These case reports illustrate an alternative reconstructive technique for large upper eyelid full thickness defect with medial canthal involvement. Two cases of upper eyelid tumours involving medial canthal region underwent staged reconstruction by glabellar flap advancement and reconstruction of the posterior lamellar with autologous graft using buccal mucosa and ear cartilage. The posterior lamellar graft and flap survived without any complication except for mild eyelid margin notching in one of the two cases. The staged reconstruction with glabellar flap advancement provides adequate defect coverage, excellent blood supply, maintains eyebrow contour and function of the eyelid. The flap also perfectly matches the surrounding tissue with minimal donor site morbidity.

Eyelid Reconstruction by the Semicircular Flap

Upper and lower eyelid defects of 40-60% can be reconstructed by the Tenzel semicircular flap technique. Lower eyelid defects of 75-80% can be successfully corrected if the lower eyelid retractors and inferior orbital septum are severed from their attachment. This technique provides several distinct advantages. It is useful for reconstruction of both the upper and lower eyelids. It can be accomplished without borrowing tissues from other sites. It provides a length about 1.5 times greater than would be available along the straight line diameter. The indications for the use of this procedure included basal cell carcinoma(4 cases), compound nevus(1 case), post-traumatic eyelid deformity(2 cases). We obtained cosmetically good results in all cases without any senous postoperative complications.