A Technique for Severe Lower Eyelid Retraction: The Fascia Lata Sling with Lateral Burr Hole.

BACKGROUND: Lower eyelid retraction is a common and feared complication of both disease processes and aesthetic and cosmetic surgical procedures. A four-finger approach has been previously described to determine adequate treatment of lid retraction. In the authors' experience, they have found that even the most aggressive treatment approach-subperiosteal cheek lift with canthopexy and interpositional graft-is inadequate to address severe lower lid retraction. METHODS: The authors propose a technique of a lower lid fascial sling with a lateral burr hole for support to be used when all five fingers are needed to correct the lower lid retraction. Review of 134 patients who underwent the fascia lata sling with lateral burr hole for severe lower lid retraction was performed. RESULTS: The fascia lata sling with lateral burr hole adequately corrected the lid retraction in all but one patient in one procedure. This patient had persistent lateral ectropion and underwent revision canthoplasty, resulting in resolution of the lateral ectropion. CONCLUSION: The fascia lata sling with lateral burr hole is a reliable procedure to correct lid retraction from a wide variety of causes.

Abdominal weakness, bulge, or hernia after DIEP flaps: An algorithm of management, prevention, and surgical repair with classification.

BACKGROUND: This study analyzes abdominal weakness, hernia, and bulge following deep inferior epigastric perforator (DIEP) flap breast reconstruction. Abdominal wall morbidities are categorized, and an algorithm for management is provided. METHODS: A retrospective review of 644 patients who underwent abdominal based flap breast reconstruction between 2009 and 2018 and met selection criteria was performed. Bulge and hernia were evaluated on exam and then by imaging and/or operative exploration. The incidence of abdominal weakness was evaluated by BREAST-Q™ data. Risk factors were analyzed. RESULTS: Of the 644 patients, 23 (3.6%) had a clinically significant bulge or hernia on exam postoperatively. Developing an abdominal wound postoperatively and sacrificing nerves both correlated with an increased incidence of bulge or hernia (p < 0.05). The use of lateral row perforators, keeping the umbilicus, higher BMI, and the use of biological mesh in the initial abdominal wall repair trended toward an increased incidence of bulge or hernia; however, these data were not statistically significant. Seven percent of patients who answered the BREAST-Q™ reported abdominal weakness. Patients in the umbilicus sacrificing cohort had an increased incidence of weakness (p < 0.05). Abdominal wounds, nerve sacrificing procedures and obesity correlated with an increased incidence of weakness; these data were not statistically significant. CONCLUSIONS: A classification and algorithm for treatment of functional abdominal wall morbidity after DIEP flap is provided. Abdominal wall morbidity is classified as: type 1 - abdominal weakness; type 2 - smaller, unilateral abdominal bulge; and type 3 - true abdominal hernia or large bilateral bulge. An algorithm of treatment is presented, which includes physical therapy and surgical repair recommendations.