Correction of severe ptosis with a silicone implant suspensor: 22 years of experience.

BACKGROUND: Patients with severe ptosis caused by poor or absent function of the levator muscle but with good frontalis muscle excursion usually benefit from a frontalis sling procedure. This is currently carried out using organic or inorganic material to connect the upper eyelid to the frontalis muscle. METHODS: The aim of this study was to evaluate retrospectively 112 patients who underwent frontalis sling procedures between 1989 and 2011 using a preformed silicone implant suspensor to correct severe ptosis. RESULTS: The results obtained using this technique were good or fair in 95.54 percent of the cases and poor in 4.46 percent of the cases. The authors discuss the results of the study and the cases in which the procedure should be indicated and highlight the advantages of the method. CONCLUSION: The availability of this low-cost sterile device, together with the fact that it is ready to use, requires less invasive surgery, saves time, and is sufficiently versatile to allow adjustments to be made at any time, makes the silicone eyelid sling an attractive choice for correcting ptosis. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, IV.

Comparative analysis of the influence of perichondrium on conjunctival epithelialization on conchal cartilage grafts in eyelid reconstruction: experimental study in rabbits.

BACKGROUND: Although the role of cartilage grafts in reconstruction of the posterior eyelid lamella is well established, spontaneous conjunctival epithelialization on such grafts has yet to be fully proven. The aim of this study was to perform a comparative analysis of the influence of perichondrium on conjunctival epithelialization over conchal cartilage grafts used in eyelid reconstruction in rabbits. METHODS: The posterior lamellae of 100 lower eyelids from 50 rabbits were reconstructed with autogenous grafts of conchal ear cartilage. In the right eyelids, cartilage was grafted with the perichondrium in direct contact with the eyeball, and the left eyelids were reconstructed in a similar manner but using cartilage grafts without perichondrium. The animals were killed after 1, 2, 3, 4, and 5 weeks, and their lower eyelids were analyzed macroscopically and histologically. RESULTS: The percentage difference in conjunctival epithelialization on the cartilage with perichondrium and that without perichondrium was 11.41 percent in the first week of the experiment, 13.64 percent in the second week, 18.69 percent in the third week, 10.38 percent in the fourth week, and 6.17 percent in the fifth week. The average percentage conjunctival epithelialization in the eyelids reconstructed with a cartilage graft with perichondrium was significantly higher throughout the 5 weeks of the experiment than in the eyelids reconstructed with cartilage without perichondrium (p < 0.0002). CONCLUSION: It was found that the perichondrium had an important role in conjunctival epithelialization in eyelids reconstructed with a cartilage graft in the present study.

Correction of blepharophimosis with silicone implant suspensor.

BACKGROUND: Blepharophimosis is a rare autosomal-dominant syndrome involving the periorbital region. It is characterized mainly by eyelid ptosis, palpebral phimosis, telecanthus, and epicanthus inversus. METHODS: Ten patients ranging in age from 2 to 22 years who presented with blepharophimosis were retrospectively studied over the past 14 years; they had an average follow-up of 7 years and 5 months. They were treated at the Division of Plastic Surgery of the Faculty of Medicine, University of São Paulo. Eight patients presented with the complete form, including epicanthus, telecanthus, and severe palpebral ptosis, and two presented with the incomplete form. The epicanthi and telecanthi were corrected with Mustardé's technique, and the ptosis was treated by frontalis suspension with a soft, preformed silicone device called the silicone implant suspensor. RESULTS: The results were classified as good, fair, and poor, according to the postoperative position of the upper eyelid in relation to the scleral limbus, medial canthus position, and residual epicanthal fold. The results were assessed as good in seven cases and fair in three. CONCLUSIONS: The silicone eyelid suspensor was effective in improving the patients' difficult condition. It was a better alternative than the use of fascia lata, because it permitted an easier readjustment of the eyelid margin and it offered the possibility of creating a well-defined palpebral fold, which is usually absent in this group. The results were maintained with long-term follow-up. The silicone suspensor was safe and long-term results were good in both children and adults.

Implante tumoral em sítio de trocarte após colecistectomia laparoscópica / Trocar-site metastasis following laparoscopic cholecystectomy

The authors present two cases of unsuspected carcinoma of the gallbladder after laparoscopic cholecystectomy in which trocar site metastasis developed during their follow-up. In the first case, a 68 year-old woman with cholecystolithiasis underwent an uneventful laparoscopic cholecystectomy. Histologic examination revealed adenocarcinoma invading the mucosa and muscular layers of the gallbladder. The patient refused additional treatment. Seven months later, metastasis developed in the umbilical port site, which was excised. In the second case, laparoscopic cholecystectomy was performed for a symptomatic gallstone in a 78 year-old man. The gallbladder inspection showed thickenning of the infundibulum wall. Histological examination revealed adenocarcinoma invading serosa. No additional treatment was performed because of the patient's advanced age. A metastasis was identified in the 5 mm port site nine months after the operation. Two hepatic metastasis were also demonstrated by ultrasonography.